MS-DRG v41 (FY 2024) MDC 03 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v41 (FY 2024) Definitions Manual • MDC 03

MDC 03 Diseases and disorders of the ear, nose, mouth and throat 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 03 Assignment of Diagnosis Codes

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

Major head and neck procedures

Patients who qualify for Major head and neck procedures 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	140	MAJOR HEAD AND NECK PROCEDURES WITH MCC	Medical
n/a	Yes	141	MAJOR HEAD AND NECK PROCEDURES WITH CC	Medical
n/a	n/a	142	MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC	Medical

Other ear, nose, mouth and throat O.R. procedures

Patients who qualify for Other ear, nose, mouth and throat O.R. procedures 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	143	OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC	Medical
n/a	Yes	144	OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC	Medical
n/a	n/a	145	OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC	Medical

Sinus and mastoid procedures

Patients who qualify for Sinus and mastoid procedures 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	135	SINUS AND MASTOID PROCEDURES WITH CC/MCC	Medical
No	136	SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC	Medical

Mouth procedures

Patients who qualify for Mouth procedures 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	137	MOUTH PROCEDURES WITH CC/MCC	Medical
No	138	MOUTH PROCEDURES WITHOUT CC/MCC	Medical

Salivary gland procedures

All patients who qualify for the subsection Salivary gland procedures will be automatically grouped into DRG 139 - SALIVARY GLAND PROCEDURES.

View the requirements to qualify for this subsection.

DRG	Name	Type
139	SALIVARY GLAND PROCEDURES	Medical

Ear, nose, mouth and throat malignancy

Patients who qualify for Ear, nose, mouth and throat malignancy 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	146	EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC	Medical
No	Yes	147	EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC	Medical
No	No	148	EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC	Medical

Dysequilibrium

All patients who qualify for the subsection Dysequilibrium will be automatically grouped into DRG 149 - DYSEQUILIBRIUM.

View the requirements to qualify for this subsection.

DRG	Name	Type
149	DYSEQUILIBRIUM	Medical

Epistaxis

Patients who qualify for Epistaxis 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	150	EPISTAXIS WITH MCC	Medical
No	151	EPISTAXIS WITHOUT MCC	Medical

Otitis media and URI

Patients who qualify for Otitis media and URI 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	152	OTITIS MEDIA AND URI WITH MCC	Medical
No	153	OTITIS MEDIA AND URI WITHOUT MCC	Medical

Other ear, nose, mouth and throat diagnoses

Patients who qualify for Other ear, nose, mouth and throat 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	154	OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC	Medical
No	Yes	155	OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC	Medical
No	No	156	OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC	Medical

Dental and oral diseases

Patients who qualify for Dental and oral diseases 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	157	DENTAL AND ORAL DISEASES WITH MCC	Medical
No	Yes	158	DENTAL AND ORAL DISEASES WITH CC	Medical
No	No	159	DENTAL AND ORAL DISEASES 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.