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| 11641334217 | 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: —MS-DRG 01 (MDC PRE) HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC —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. | 0 | |
| 11641337017 | sex | 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, prostate cancer, hydrocele, torsion of testicle, Male Procedures, orchiectomy, prostatectomy, vasectomy, Female Diagnoses, endometriosis of ovary, dysmenorrhea, tubal pregnancy, Female Procedures, salpingo-oophorectomy, hysterectomy, dilation and curettage (D&C) | 1 | |
| 11641340543 | age | If a patient in one age group tends to use more resources than patients in another age group, then the MS-DRGs are split according to age. | 2 | |
| 11641352277 | discharge status | When a patient is transferred from one acute care hospital to another or from one acute care hospital to a certain postacute care provider (e.g., skilled nursing facility), the payment for some MS-DRGs is reduced. The MS-DRGs affected by being transferred to specific post-acute care facilities is known as Post-Acute DRG. Medicare identifies those MS-DRGs with an indicator of "Yes." An example would be MS-DRG 031 Ventricular Shunt Procedure w MCC. | 3 | |
| 11641352278 | presence or absence of major complications and comorbidities (MCCs) | The presence of a major complication or comorbidity diagnosis can cause the patient's case to be grouped into the higher-weighted MS-DRG. After determining if a MCC is present or not, the logic reviews for complications and comorbidities (CCs). | 4 | |
| 11641365376 | presence or absence of complications and comorbidities (CCs) | 6 | 5 |
