MS-DRG v35 (FY 2018) Pre | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v35 (FY 2018) Definitions Manual • Pre

Pre-MDC is broken down into subgroups, listed here from most to least resource intensive. If a patient received qualifying treatment in listed in more than one subgroup, the first one listed will determine the DRG assigned to the patient.

To determine if a patient qualifies for a subgroup, click on the subgroup name and check the requirements listed. Typically, each subgroup requires one of a serious of ICD-10-CM diagnostic codes or PCS codes to have been assigned to the patient.

Heart Transplant or Implant of Heart Assist System

Patients who qualify for Heart Transplant or Implant of Heart Assist System will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

MCC	DRG	Name	Type
Yes	001	HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC	Medical
No	002	HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC	Medical

ECMO or Tracheostomy with MV >96 Hours or PDX Except Face, Mouth and Neck

Patients who qualify for ECMO or Tracheostomy with MV >96 Hours or PDX Except Face, Mouth and Neck will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

ECMO	Tracheostomy	Major O.R.Procedure	DRG	Name	Type
Yes	n/a	n/a	003	ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PDX EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURE	Medical
No	Yes	Yes	003	ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PDX EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURE	Medical
No	Yes	No	004	TRACHEOSTOMY WITH MV >96 HOURS OR PDX EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURE	Medical

Liver or Intestinal Transplant

Patients who qualify for Liver or Intestinal Transplant will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

Liver Transplant	Intestinal Transplant	MCC	DRG	Name	Type
Yes	Yes	n/a	005	LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT	Medical
No	Yes	n/a	005	LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT	Medical
Yes	No	Yes	005	LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT	Medical
Yes	No	No	006	LIVER TRANSPLANT WITHOUT MCC	Medical

Allogeneic Bone Marrow Transplant

All patients who qualify for the subsection Allogeneic Bone Marrow Transplant will be automatically grouped into DRG 014 - ALLOGENEIC BONE MARROW TRANSPLANT.

View the requirements to qualify for this subsection.

DRG	Name	Type
014	ALLOGENEIC BONE MARROW TRANSPLANT	Medical

Lung Transplant

All patients who qualify for the subsection Lung Transplant will be automatically grouped into DRG 007 - LUNG TRANSPLANT.

View the requirements to qualify for this subsection.

DRG	Name	Type
007	LUNG TRANSPLANT	Medical

Simultaneous Pancreas/Kidney Transplant

All patients who qualify for the subsection Simultaneous Pancreas/Kidney Transplant will be automatically grouped into DRG 008 - SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT.

View the requirements to qualify for this subsection.

DRG	Name	Type
008	SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT	Medical

Autologous Bone Marrow Transplant

Patients who qualify for Autologous Bone Marrow Transplant will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

CC or MCC	DRG	Name	Type
Yes	016	AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC	Medical
No	017	AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC	Medical

Pancreas Transplant

All patients who qualify for the subsection Pancreas Transplant will be automatically grouped into DRG 010 - PANCREAS TRANSPLANT.

View the requirements to qualify for this subsection.

DRG	Name	Type
010	PANCREAS TRANSPLANT	Medical

Tracheostomy for Face, Mouth and Neck Diagnoses

Patients who qualify for Tracheostomy for Face, Mouth and Neck Diagnoses will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

MCC	CC	DRG	Name	Type
Yes	n/a	011	TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES WITH MCC	Medical
No	Yes	012	TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES WITH CC	Medical
No	No	013	TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES WITHOUT CC/MCC	Medical

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.