DRG - Disease Related Groups

This option is available to Advanced subscribers only.

Watch a short YouTube movie and see how easy it is to find the correct DRG code with ICD10Doc.

Note There are seral types of DRG classification systems used for INPATIENTS hospital payments.
ICD10Doc uses only the MS-DRG (Medicare Severity DRG) which is mantained by CMS. CMS has recently released the DRG with ICD-10 Diagnosis and Procedures codes. Thus, ICD10Doc application uses the crosswalk / mapping to and from DRG using ONLY the ICD-10 set of codes and none of the ICD-9 codes.

1. You can search for a DRG using the free-text search from the landing page or using the DRG group number and the reverse search functionality.



On the intial results page, in the DRG box - you can click on the MDC number (Major Diagnostic Group) link and review all DRGs belonging to this group or the DRG link that will take you to the DRG details page.



On the DRG details page, you can review the DRG weight (which in turn will define the actual amount to be paid), Geometric and Arithmetic mean LOS, Post-Acute DRG, Special Pay DRG and the Diagnosis and Procedures related to this DRG.





2. When reviewing an ICD-10 code (Diagnosis or Procedure) that interests you, in the DRG related information box, you may see DRG related information such as CC / MCC (Complications & Comorbidities or Major Complications & Comorbidities), Exclusion criteria, Non-OR procedures, Procedure clusters and etc.





See below details on the various parameters related to DRG

Background

Diagnosis-related group (DRG) is a system to classify hospital cases into one of 751 groups.
Multiple Diagnosis and / or Procedures will translate to ONE DRG per hospital encounter. The algorithm used in the DRG GROUPER module is explained elsewhere.
A diagnosis or procedure may be classified into many DRG. Usually, the lower the DRG number the higher the reimbursement for the hospital.

Most of the DRG are either "with CC", "with MCC" or "without CC/MCC".
A SECONDARY diagnosis may be considered as a CC or MCC, unless the PRIMRY diagnosis excludes it from being considered a complication, comorbidity or major complication.
There are several diagnosis that may be considered as MCC only if the patient was discharged alive. If patient has died these diagnosis can be assigned as CC (and NOT MCC)

Unless otherwise mentioned, a procedure is considered an OR procedure. Some procedures are always assigned as Non-OR procedures.
2 or more procedures may be clustered and assigned a DRG accordingly. When more than one procedure was performed during the hospital encounter, make sure that you pick the right procedures cluster when assigning the DRG.
When one of the procedures in the cluster is considered OR and the other Non-OR, the DRG may define whether the cluster should be classified as OR or Non-OR.

ICD10Doc application provides all the above mentioned information on DRG.

For more information on DRG visit CMS web site or Wikipedia
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