Enhanced MS-DRG Definitions Manual

MS-DRG v40 (FY 2023) Definitions Manual • MDC 20 • Alcohol, drug abuse or dependence

DRG Assignment Logic for Alcohol, drug abuse or dependence

Patients who qualify for Alcohol, drug abuse or dependence will be grouped into a DRG according to the logic below.

Rehabilitation Therapy MCC DRG Name Type
Yes n/a 895 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY Medical
No Yes 896 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC Medical
No No 897 ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT 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.

ALCOHOL/DRUG ABUSE OR DEPENDENCE PRINCIPAL DIAGNOSIS IN MDC 20 REHABILITATION THERAPY NON-OPERATING ROOM PROCEDURES

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.

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