List of DRG codes

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The DRGs, as they are now defined, form a manageable, clinically coherent set of patient classes that relate a hospital’s case mix to the resource demands and associated costs experienced by the hospital. DRGs are defined based on the principal diagnosis, secondary diagnoses, surgical procedures, age, sex and discharge status of the patients treated. Through DRGs, hospitals can gain an understanding of the patients being treated, the costs incurred and within reasonable limits, the services expected to be required. The classification of patients into DRGs is a constantly evolving process. As coding schemes change, as more comprehensive data is collected or as medical technology or practice changes, the DRG definitions will be reviewed and revised. DRG versions 2.0–32.0 were defined using the ICD-9-CM codeset. MS-DRG v34.0 was implemented using the ICD-10-CM/PCS codeset effective October 1, 2016.

About DRG codes

Within each MDC, the MS-DRGs are listed in the order in which the grouper recognizes them. This enables users to see instances where grouper logic order differs from strict numerical order.

Each of the Medicare Severity Diagnosis Related Groups is defined by a particular set of patient attributes which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.

For each Major Diagnostic Category the following material is provided: 1. A logic table depicting the MS-DRG structure for the Major Diagnostic Category. 2. A listing of all the ICD-10-CM diagnoses assigned to the Major Diagnostic Category. 3. A detailed description of patient attributes which define each MS-DRG in the Major Diagnostic Category. The tree diagrams have been replaced with logic tables. Each logic table specifies in its columns specific conditions which determine the MS-DRG assigned. The rows specify individual MSDRGs. Each cell in the logic table indicates whether a specific condition in the column is necessary for the MS-DRG in the row to be assigned. The combination of the cells which are required for a specific MS-DRG represent a complete description of the assignment logic for that MS-DRG. In the sample logic table below, discharge status and the presence of either an MCC or CC will define the MS-DRG assignment. With a discharge status indicating that patient was discharged alive, the presence of an MCC would assign to MS-DRG 280, a CC would assign to MS-DRG 281, while having neither would assign to MS-DRG 282. If the discharge status indicates the patient died, an MCC would assign to MS-DRG 283, a CC would assign to MS-DRG 284, while having neither an MCC or CC would assign to MS-DRG 285.

List of DRG code categories

  • MDC 01 - Diseases & Disorders of the Nervous System
  • MDC 02 - Diseases & Disorders of the Eye
  • MDC 03 - Diseases & Disorders of the Ear, Nose, Mouth & Throat
  • MDC 04 - Diseases & Disorders of the Respiratory System
  • MDC 05 - Diseases & Disorders of the Circulatory System
  • MDC 06 - Diseases & Disorders of the Digestive System
  • MDC 07 - Diseases & Disorders of the Hepatobiliary System & Pancreas
  • MDC 08 - Diseases & Disorders of the Musculoskeletal System & Connective Tissue
  • MDC 09 - Diseases & Disorders of the Skin, Subcutaneous Tissue & Breast
  • MDC 10 - Endocrine, Nutritional & Metabolic Diseases & Disorders
  • MDC 11 - Diseases & Disorders of the Kidney & Urinary Tract
  • MDC 12 - Diseases & Disorders of the Male Reproductive System
  • MDC 13 - Diseases & Disorders of the Female Reproductive System
  • MDC 14 - Pregnancy, Childbirth & the Puerperium
  • MDC 15 - Newborns & Other Neonates with Conditions Originating in Perinatal Period
  • MDC 16 - Diseases & Disorders of Blood, Blood Forming Organs, Immunologic Disorders
  • MDC 17 - Myeloproliferative Diseases & Disorders, Poorly Differentiated Neoplasms
  • MDC 18 - Infectious & Parasitic Diseases, Systemic or Unspecified Sites
  • MDC 19 - Mental Diseases & Disorders
  • MDC 20 - Alcohol/Drug Use & Alcohol/Drug Induced Organic Mental Disorders
  • MDC 21 - Injuries, Poisonings & Toxic Effects of Drugs
  • MDC 22 - Burns
  • MDC 23 - Factors Influencing Health Status & Other Contacts with Health Services
  • MDC 24 - Multiple Significant Trauma
  • MDC 25 - Human Immunodeficiency Virus Infections

Appendixes

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