What Are Some DRG Codes, and How Are They Assigned?


Quick Answer

Some diagnostic related groupings codes include MS-DRG 469, Major Joint Replacement or Reattachment of Lower Extremity With MCC; DRG 539, Osteomyelitis with MCC; and MS-DRG 129, Major Head and Neck Procedures, according to About.com. Medicare and health insurers use these codes to determine payments. Hospitals determine a patient's diagnostic related groupings code by considering the principal diagnosis, whether the patient received surgery and if there were complications.

Continue Reading
Related Videos

Full Answer

Using diagnostic related groupings allows Medicare and health insurers to pay hospitals based on the patient's diagnosis rather than the specific costs the hospital incurred in treating that patient, explains About.com. Regulators designed the system to control health care costs by encouraging hospitals to keep their expenses below the reimbursement amounts for the applicable code.

Medicare Severity diagnostic related groupings use codes 1 through 999, according to the Centers for Medicare & Medicaid Services. Each type of diagnosis typically has three variants: one for diagnosis without comorbid condition, one for comorbid condition and one for major comorbid condition, with each increasing the final payment amount, explains About.com. Comorbidity refers to the presence of other diseases or disorders. For instance, MS-DRG 088 refers to patients admitted to hospital for concussion with a major comorbid condition, whereas MS-DRG 090 refers to patients admitted to hospital with only a concussion, as of 2014, states the Centers for Medicare a& Medicaid Services.

Learn more about Health Insurance

Related Questions