MS-DRG v40 (FY 2023) MDC 15 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v40 (FY 2023) Definitions Manual • MDC 15

MDC 15 Newborns and other neonates with conditions originating in perinatal period 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.

MDC 15 Assignment of Diagnosis Codes

To qualify for any subsection in this MDC, the patient's primary diagnostic code must be included in this list.

Neonates, died or transferred to another acute care facility

All patients who qualify for the subsection Neonates, died or transferred to another acute care facility will be automatically grouped into DRG 789 - NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY.

View the requirements to qualify for this subsection.

DRG	Name	Type
789	NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY	Medical

Normal newborn

All patients who qualify for the subsection Normal newborn will be automatically grouped into DRG 795 - NORMAL NEWBORN.

View the requirements to qualify for this subsection.

DRG	Name	Type
795	NORMAL NEWBORN	Medical

Extreme immaturity or respiratory distress syndrome, neonate

All patients who qualify for the subsection Extreme immaturity or respiratory distress syndrome, neonate will be automatically grouped into DRG 790 - EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE.

View the requirements to qualify for this subsection.

DRG	Name	Type
790	EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE	Medical

Prematurity

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

Major Problems	DRG	Name	Type
Yes	791	PREMATURITY WITH MAJOR PROBLEMS	Medical
No	792	PREMATURITY WITHOUT MAJOR PROBLEMS	Medical

Full term neonate with major problems

All patients who qualify for the subsection Full term neonate with major problems will be automatically grouped into DRG 793 - FULL TERM NEONATE WITH MAJOR PROBLEMS.

View the requirements to qualify for this subsection.

DRG	Name	Type
793	FULL TERM NEONATE WITH MAJOR PROBLEMS	Medical

Neonate with other significant problems

All patients who qualify for the subsection Neonate with other significant problems will be automatically grouped into DRG 794 - NEONATE WITH OTHER SIGNIFICANT PROBLEMS.

View the requirements to qualify for this subsection.

DRG	Name	Type
794	NEONATE WITH OTHER SIGNIFICANT PROBLEMS	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.