MS-DRG v35 (FY 2018) MDC 14 Cesarean Section | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v35 (FY 2018) Definitions Manual • MDC 14 • Cesarean Section

DRG Assignment Logic for Cesarean Section

Patients who qualify for Cesarean Section will be grouped into a DRG according to the logic below.

CC or MCC	SDX Twins	PDX Malpresentation	DRG	Name	Type
Yes	No	No	765	CESAREAN SECTION WITH CC/MCC	Medical
No	Yes	No	765	CESAREAN SECTION WITH CC/MCC	Medical
No	No	Yes	766	CESAREAN SECTION WITHOUT CC/MCC	Medical
No	Yes	Yes	766	CESAREAN SECTION WITHOUT CC/MCC	Medical
No	No	No	766	CESAREAN SECTION WITHOUT CC/MCC	Medical

Detailed Rules

The tables below list the codes required to qualify for this subsection according to the logic listed above. By matching the codes on a patient's account to those listed below, you can work out how a patient will be grouped by the MS-DRG grouper. However, sometimes this can be difficult to work out by hand. If you are looking for automated DRG grouping software that can be integrated into your workflow, please let us know.

OPERATING ROOM PROCEDURES

Codes in OPERATING ROOM PROCEDURES
Code	Description
10D00Z0	Extraction of Products of Conception, Classical, Open Approach
10D00Z1	Extraction of Products of Conception, Low Cervical, Open Approach
10D00Z2	Extraction of Products of Conception, Extraperitoneal, Open Approach

CC FOR CSECTION

Codes in CC FOR CSECTION
Code	Description
O13.1	Gestational [pregnancy-induced] hypertension without significant proteinuria, first trimester
O13.2	Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
O13.3	Gestational [pregnancy-induced] hypertension without significant proteinuria, third trimester
O16.9	Unspecified maternal hypertension, unspecified trimester
O22.91	Venous complication in pregnancy, unspecified, first trimester
O22.92	Venous complication in pregnancy, unspecified, second trimester
O22.93	Venous complication in pregnancy, unspecified, third trimester
O24.92	Unspecified diabetes mellitus in childbirth
O26.21	Pregnancy care for patient with recurrent pregnancy loss, first trimester
O26.22	Pregnancy care for patient with recurrent pregnancy loss, second trimester
O26.23	Pregnancy care for patient with recurrent pregnancy loss, third trimester
O26.51	Maternal hypotension syndrome, first trimester
O26.52	Maternal hypotension syndrome, second trimester
O26.53	Maternal hypotension syndrome, third trimester
O36.5113	Maternal care for known or suspected placental insufficiency, first trimester, fetus 3
O36.5114	Maternal care for known or suspected placental insufficiency, first trimester, fetus 4
O36.5115	Maternal care for known or suspected placental insufficiency, first trimester, fetus 5
O36.5119	Maternal care for known or suspected placental insufficiency, first trimester, other fetus
O36.5120	Maternal care for known or suspected placental insufficiency, second trimester, not applicable or unspecified
O36.5121	Maternal care for known or suspected placental insufficiency, second trimester, fetus 1
O36.5123	Maternal care for known or suspected placental insufficiency, second trimester, fetus 3
O36.5124	Maternal care for known or suspected placental insufficiency, second trimester, fetus 4
O36.5125	Maternal care for known or suspected placental insufficiency, second trimester, fetus 5
O36.5129	Maternal care for known or suspected placental insufficiency, second trimester, other fetus
O36.5130	Maternal care for known or suspected placental insufficiency, third trimester, not applicable or unspecified
O36.5131	Maternal care for known or suspected placental insufficiency, third trimester, fetus 1
O36.5132	Maternal care for known or suspected placental insufficiency, third trimester, fetus 2
O36.5133	Maternal care for known or suspected placental insufficiency, third trimester, fetus 3
O36.5134	Maternal care for known or suspected placental insufficiency, third trimester, fetus 4
O36.5135	Maternal care for known or suspected placental insufficiency, third trimester, fetus 5
O36.5139	Maternal care for known or suspected placental insufficiency, third trimester, other fetus
O36.5910	Maternal care for other known or suspected poor fetal growth, first trimester, not applicable or unspecified
O36.5911	Maternal care for other known or suspected poor fetal growth, first trimester, fetus 1
O36.5912	Maternal care for other known or suspected poor fetal growth, first trimester, fetus 2
O36.5913	Maternal care for other known or suspected poor fetal growth, first trimester, fetus 3
O36.5914	Maternal care for other known or suspected poor fetal growth, first trimester, fetus 4
O36.5915	Maternal care for other known or suspected poor fetal growth, first trimester, fetus 5
O36.5919	Maternal care for other known or suspected poor fetal growth, first trimester, other fetus
O36.5920	Maternal care for other known or suspected poor fetal growth, second trimester, not applicable or unspecified
O36.5921	Maternal care for other known or suspected poor fetal growth, second trimester, fetus 1
O36.5922	Maternal care for other known or suspected poor fetal growth, second trimester, fetus 2
O36.5923	Maternal care for other known or suspected poor fetal growth, second trimester, fetus 3
O36.5924	Maternal care for other known or suspected poor fetal growth, second trimester, fetus 4
O36.5925	Maternal care for other known or suspected poor fetal growth, second trimester, fetus 5
O36.5929	Maternal care for other known or suspected poor fetal growth, second trimester, other fetus
O36.5930	Maternal care for other known or suspected poor fetal growth, third trimester, not applicable or unspecified
O36.5931	Maternal care for other known or suspected poor fetal growth, third trimester, fetus 1
O36.5932	Maternal care for other known or suspected poor fetal growth, third trimester, fetus 2
O36.5933	Maternal care for other known or suspected poor fetal growth, third trimester, fetus 3
O36.5934	Maternal care for other known or suspected poor fetal growth, third trimester, fetus 4
O36.5935	Maternal care for other known or suspected poor fetal growth, third trimester, fetus 5
O36.5939	Maternal care for other known or suspected poor fetal growth, third trimester, other fetus
O40.1XX0	Polyhydramnios, first trimester, not applicable or unspecified
O40.1XX1	Polyhydramnios, first trimester, fetus 1
O40.1XX2	Polyhydramnios, first trimester, fetus 2
O40.1XX3	Polyhydramnios, first trimester, fetus 3
O40.1XX4	Polyhydramnios, first trimester, fetus 4
O40.1XX5	Polyhydramnios, first trimester, fetus 5
O40.1XX9	Polyhydramnios, first trimester, other fetus
O40.2XX0	Polyhydramnios, second trimester, not applicable or unspecified
O40.2XX1	Polyhydramnios, second trimester, fetus 1
O40.2XX2	Polyhydramnios, second trimester, fetus 2
O40.2XX3	Polyhydramnios, second trimester, fetus 3
O40.2XX4	Polyhydramnios, second trimester, fetus 4
O40.2XX5	Polyhydramnios, second trimester, fetus 5
O40.2XX9	Polyhydramnios, second trimester, other fetus
O40.3XX0	Polyhydramnios, third trimester, not applicable or unspecified
O40.3XX1	Polyhydramnios, third trimester, fetus 1
O40.3XX2	Polyhydramnios, third trimester, fetus 2
O40.3XX3	Polyhydramnios, third trimester, fetus 3
O40.3XX4	Polyhydramnios, third trimester, fetus 4
O40.3XX5	Polyhydramnios, third trimester, fetus 5
O40.3XX9	Polyhydramnios, third trimester, other fetus
O41.8X10	Other specified disorders of amniotic fluid and membranes, first trimester, not applicable or unspecified
O41.8X11	Other specified disorders of amniotic fluid and membranes, first trimester, fetus 1
O41.8X12	Other specified disorders of amniotic fluid and membranes, first trimester, fetus 2
O41.8X13	Other specified disorders of amniotic fluid and membranes, first trimester, fetus 3
O41.8X14	Other specified disorders of amniotic fluid and membranes, first trimester, fetus 4
O41.8X15	Other specified disorders of amniotic fluid and membranes, first trimester, fetus 5
O41.8X19	Other specified disorders of amniotic fluid and membranes, first trimester, other fetus
O41.8X20	Other specified disorders of amniotic fluid and membranes, second trimester, not applicable or unspecified
O41.8X21	Other specified disorders of amniotic fluid and membranes, second trimester, fetus 1
O41.8X22	Other specified disorders of amniotic fluid and membranes, second trimester, fetus 2
O41.8X23	Other specified disorders of amniotic fluid and membranes, second trimester, fetus 3
O41.8X24	Other specified disorders of amniotic fluid and membranes, second trimester, fetus 4
O41.8X25	Other specified disorders of amniotic fluid and membranes, second trimester, fetus 5
O41.8X29	Other specified disorders of amniotic fluid and membranes, second trimester, other fetus
O41.8X30	Other specified disorders of amniotic fluid and membranes, third trimester, not applicable or unspecified
O41.8X31	Other specified disorders of amniotic fluid and membranes, third trimester, fetus 1
O41.8X32	Other specified disorders of amniotic fluid and membranes, third trimester, fetus 2
O41.8X33	Other specified disorders of amniotic fluid and membranes, third trimester, fetus 3
O41.8X34	Other specified disorders of amniotic fluid and membranes, third trimester, fetus 4
O41.8X35	Other specified disorders of amniotic fluid and membranes, third trimester, fetus 5
O41.8X39	Other specified disorders of amniotic fluid and membranes, third trimester, other fetus
O72.2	Delayed and secondary postpartum hemorrhage
O72.3	Postpartum coagulation defects
O91.111	Abscess of breast associated with pregnancy, first trimester
O91.112	Abscess of breast associated with pregnancy, second trimester
O91.113	Abscess of breast associated with pregnancy, third trimester
O91.12	Abscess of breast associated with the puerperium

MALPRESENTATION

Codes in MALPRESENTATION
Code	Description
O32.9XX0	Maternal care for malpresentation of fetus, unspecified, not applicable or unspecified
O32.9XX1	Maternal care for malpresentation of fetus, unspecified, fetus 1
O32.9XX2	Maternal care for malpresentation of fetus, unspecified, fetus 2
O32.9XX3	Maternal care for malpresentation of fetus, unspecified, fetus 3
O32.9XX4	Maternal care for malpresentation of fetus, unspecified, fetus 4
O32.9XX5	Maternal care for malpresentation of fetus, unspecified, fetus 5
O32.9XX9	Maternal care for malpresentation of fetus, unspecified, other fetus

TWINS

Codes in TWINS
Code	Description
O30.001	Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester
O30.002	Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester
O30.003	Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester
O30.011	Twin pregnancy, monochorionic/monoamniotic, first trimester
O30.012	Twin pregnancy, monochorionic/monoamniotic, second trimester
O30.013	Twin pregnancy, monochorionic/monoamniotic, third trimester
O30.031	Twin pregnancy, monochorionic/diamniotic, first trimester
O30.032	Twin pregnancy, monochorionic/diamniotic, second trimester
O30.033	Twin pregnancy, monochorionic/diamniotic, third trimester
O30.041	Twin pregnancy, dichorionic/diamniotic, first trimester
O30.042	Twin pregnancy, dichorionic/diamniotic, second trimester
O30.043	Twin pregnancy, dichorionic/diamniotic, third trimester
O30.091	Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester
O30.092	Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester
O30.093	Twin pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester

About the Turquoise Health MS-DRG Manual Browser

We build tools and machine learning systems that simplify healthcare revenue cycle operations. We were frustrated with the formatting of the MS-DRG rules, so we built our own solution.

MS-DRG rules and ICD-10 CM/PCS codes are automatically parsed from CMS's MS-DRG data files. All content is provided strictly “AS IS” and may contain parsing errors. If you spot an error, please let us know.

We have converted the MS-DRG logic into fully structured, machine-readable data. If you need structured data versions of the MS-DRG manuals, we would love to talk with you.