RSV infection primarily manifests as bronchiolitis or pneumonia and results in approximately 75,000 to 125,000 hospitalizations in the United States each year (1).
Back in 1996, RSV was added as a specific code (0796). Since there are very few cases of RSV in MedPAR data, the panel chose to assign it as a non-CC. The CMS “CC Analysis” clearly shows that RSV should be a CC, even with the low volume of cases.
0796 RESPIRATORY SYNCYTIAL VIRUS (RSV)
Cnt1 = 18
C1=1.615
Cnt2=91
C2= 2.773
Cnt3=32
C3=3.284
I don’t understand how they can make this decision knowing that the MS-DRGs would be adopted by non-Medicare payers.
Fortunately, the combination code of RSV pneumonia (4801) is assigned as a MCC in MS-DRGs while acute RSV bronchiolitis (46611) is a CC.
In the AP grouper (V23), none of the codes for RSV are CCs or MCCs.
Go figure.
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Filed under: classifications, clinical, drg | Tagged: rsv msdrg
