Why does the principal diagnosis matter for CRT-D implants?
In 2003, defibrillator DRGs and their associated description changed. When a patient has a principal diagnosis of heart failure (HF), acute myocardial infarction (AMI), or Shock, an EP study and CRT-D implant will result in assignment to DRG 535. However, if HF, AMI or Shock is not indicated as a principal diagnosis, it results in assignment to DRG 536, a lower paying DRG. Because a DRG assignment is based on the principal diagnosis, if heart failure is applicable and appropriately documented within the medical record or operative report, its presence as a principal diagnosis will result in a higher paying DRG for the hospital.
