MS-DRG Assignment
groupers - ✔️✔️today, most MS-DRGs are calculated using software tools known as
groupers. Early on, they were determined using a flow-chart book. The book contains a
series of decision tree diagrams. The same information would have been necessary to
determine the correct DRG (as MS-DRGs were not implemented).
Principal and Secondary Diagnosis and Procedure Codes - ✔️✔️Does the logic look
for a principal procedure code first?
-If no, then a principal diagnosis code is reviewed for appropriate placement in an MDC
(major diagnostic category).
-If yes, then logic follows the surgical MS-DRGs pathways for the admission.
-Next question: "Does the procedure code fall into the pre MDC MS-DRG?" If yes, a
MS-DRG is assigned.
--Currently, there are 17 pre-MDC groups.
--Examples include:
a) MS-DRG 01 (MDC PRE) HEART TRANSPLANT OR IMPLANT OF HEART ASSIST
SYSTEM W MCC
b) MS-DRG 014 (MDC PRE) ALLOGENIC BONE MARROW TRANSPLANT
-If no, pre MDC the remaining grouper logic is followed.
Secondary diagnosis codes are reviewed after the principal diagnosis for the selection
of the correct MS-DRG.
The medical coder identifies all the principal and secondary diagnosis and procedure
codes. This will lead to the assignment of the correct DRG.
Remember the factors influencing MS-DRG assignment: - ✔️✔️1. principal and
secondary diagnosis and procedure codes
2. sex
3. age
4. discharge status
5. presence or absence of major complications and comorbidities (MCCs)
6. presence or absence of complications and comorbidities (CCs)
Sex of the Patient - ✔️✔️There are specific codes and MS-DRGs that are gender
specific. Certain diagnoses and procedures can only be assigned to males or females.
Examples of these include the following:
-Male Diagnoses
groupers - ✔️✔️today, most MS-DRGs are calculated using software tools known as
groupers. Early on, they were determined using a flow-chart book. The book contains a
series of decision tree diagrams. The same information would have been necessary to
determine the correct DRG (as MS-DRGs were not implemented).
Principal and Secondary Diagnosis and Procedure Codes - ✔️✔️Does the logic look
for a principal procedure code first?
-If no, then a principal diagnosis code is reviewed for appropriate placement in an MDC
(major diagnostic category).
-If yes, then logic follows the surgical MS-DRGs pathways for the admission.
-Next question: "Does the procedure code fall into the pre MDC MS-DRG?" If yes, a
MS-DRG is assigned.
--Currently, there are 17 pre-MDC groups.
--Examples include:
a) MS-DRG 01 (MDC PRE) HEART TRANSPLANT OR IMPLANT OF HEART ASSIST
SYSTEM W MCC
b) MS-DRG 014 (MDC PRE) ALLOGENIC BONE MARROW TRANSPLANT
-If no, pre MDC the remaining grouper logic is followed.
Secondary diagnosis codes are reviewed after the principal diagnosis for the selection
of the correct MS-DRG.
The medical coder identifies all the principal and secondary diagnosis and procedure
codes. This will lead to the assignment of the correct DRG.
Remember the factors influencing MS-DRG assignment: - ✔️✔️1. principal and
secondary diagnosis and procedure codes
2. sex
3. age
4. discharge status
5. presence or absence of major complications and comorbidities (MCCs)
6. presence or absence of complications and comorbidities (CCs)
Sex of the Patient - ✔️✔️There are specific codes and MS-DRGs that are gender
specific. Certain diagnoses and procedures can only be assigned to males or females.
Examples of these include the following:
-Male Diagnoses
