Regarding MS-DRG determination. I am reviewing a claim in which the hospital applied a ICD-10 S06.6X6A (Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter) as the admitting, 00N.00ZZ (PCS code) – Release Brain, Open Approach as the principal diagnosis code and ICD-10 J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia as the secondary diagnosis code. I am a CPC, not certified in hospital coding. However I am not used to seeing PCS codes being used as principal diagnosis codes and am wondering if this is normal?

Also, the provider used an MS DRG (166- OTHER RESP SYSTEM O.R. PROCEDURES W MCC) but put the DRG in box 73 of the UB form, which I see from time to time, but it is odd considering I generally see the DRG placed in box 71 of the UB04 form, which is where it is supposed to be placed. I am also curious about this and wondered if anyone has any thoughts or guidance as if this is acceptible.

The main concern being the placement of a PCS code as the principal DX and the DRG assigned to the claim (if that is the DRG, although this is an inpatient claim) does not fit with the services that were rendered for the patient which appear to related to brain trauma, the majority of the other DX codes listed on the claim relate to brain trauma and coma scales. I do not feel the DRG is appropriate for the case based on how DRGs are typically selected and am looking for guidance.