MS-DRG Grouper for ICD-10-CM and ICD-10-PCS - Diagnosis-Related Groups

quickly calculate the DRG based on ICD-10-CM and ICD-10-PCS codes

The DRG-Grouper is used to calculate payments to cover operating costs for inpatient hospital stays. Under the inpatient prospective payment system (IPPS) each individual case is categorized into a diagnosis related group – DRG. Payment weights are assigned to each DRG based on average resources used to treat Medicare patients in that DRG.

Access to this feature is available in the following products:

Facility Inpatient Reimbursement Tools
Find-A-Code Facility Complete

Select the "demo" button to view sample results.

About Diagnosis-Related Groups (DRG)

Enter a ICD-10-CM principle diagnosis, as well as any ICD-10-CM secondary diagnoses and ICD-10-PCS procedures, in the boxes below. Select the "more" links for additional boxes. When done, select the "group" button. The resultant DRG will display below.

more Switch to ICD-9 Grouper MS-DRG Grouper Tutorial (PDF) MS-DRG CC/MCC List

incident details

ICD-10 Codes	POA	Description (will appear for codes) Legend

Principal Dx (ICD-10-CM)

Secondary Dx (ICD-10-CM)

+ more Diagnosis

Procedures (ICD-10-PCS)

+ more Procedures

Discharge Date

(optional - not used in grouping)

Admitting Diagnosis

(0-124)

Age

Gender

Discharge Status

Hospital Provider Number

Code	Reason for Code
Y	Diagnosis was present at time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "Y" for the POA Indicator.
N	Diagnosis was not present at time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "N" for the POA Indicator.
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "U" for the POA Indicator.
W	Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission. CMS will pay the CC/MCC DRG for those selected HACs that are coded as "W" for the POA Indicator.
1	Unreported/Not used. Exempt from POA reporting. This code is equivalent to a blank on the UB-04, however; it was determined that blanks are undesirable when submitting this data via the 4010A. CMS will not pay the CC/MCC DRG for those selected HACs that are coded as "1" for the POA Indicator. The “1” POA Indicator should not be applied to any codes on the HAC list. For a complete list of codes on the POA exempt list, see the Official Coding Guidelines for ICD-10-CM.

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CC	Constitutes a Complication/Comorbidity (CC) when used as a Secondary Diagnoses
MCC	Constitutes a Major Complication/Comorbidity (MCC) when used as a Secondary Diagnoses
HAC-Dependent	Complication status is dependent on whether this condition was Present On Admission (POA) or hospital acquired.
DS-Dependent	Complication status is dependent on the patient's Discharge Status.
OR	Operating Room Procedure
OR in Combo	Potential Operating Room Procedure, when used in combination with other specific procedures

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MS-DRG Grouper for ICD-10-CM and ICD-10-PCS - Diagnosis-Related Groups

quickly calculate the DRG based on ICD-10-CM and ICD-10-PCS codes