MS-DRG v41 (FY 2024) MDC 04 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v41 (FY 2024) Definitions Manual • MDC 04

MDC 04 Diseases and disorders of the respiratory system 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 04 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 chest procedures

Patients who qualify for Major chest 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	163	MAJOR CHEST PROCEDURES WITH MCC	Medical
No	Yes	164	MAJOR CHEST PROCEDURES WITH CC	Medical
No	No	165	MAJOR CHEST PROCEDURES WITHOUT CC/MCC	Medical

Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism

All patients who qualify for the subsection Ultrasound accelerated and other thrombolysis with principal diagnosis pulmonary embolism will be automatically grouped into DRG 173 - ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM.

View the requirements to qualify for this subsection.

DRG	Name	Type
173	ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM	Medical

Other respiratory system O.R. procedures

Patients who qualify for Other respiratory system 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	166	OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC	Medical
No	Yes	167	OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC	Medical
No	No	168	OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC	Medical

Respiratory system diagnosis with ventilator support

Patients who qualify for Respiratory system diagnosis with ventilator support will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.

MV >96 Hours	DRG	Name	Type
Yes	207	RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS	Medical
No	208	RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS	Medical

Pulmonary embolism

Patients who qualify for Pulmonary embolism 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	175	PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE	Medical
No	176	PULMONARY EMBOLISM WITHOUT MCC	Medical

Respiratory infections and inflammations

Patients who qualify for Respiratory infections and inflammations 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	177	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC	Medical
No	Yes	178	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC	Medical
No	No	179	RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC	Medical

Respiratory neoplasms

Patients who qualify for Respiratory neoplasms 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	180	RESPIRATORY NEOPLASMS WITH MCC	Medical
No	Yes	181	RESPIRATORY NEOPLASMS WITH CC	Medical
No	No	182	RESPIRATORY NEOPLASMS WITHOUT CC/MCC	Medical

Major chest trauma

Patients who qualify for Major chest trauma 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	183	MAJOR CHEST TRAUMA WITH MCC	Medical
No	Yes	184	MAJOR CHEST TRAUMA WITH CC	Medical
No	No	185	MAJOR CHEST TRAUMA WITHOUT CC/MCC	Medical

Pleural effusion

Patients who qualify for Pleural effusion 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	186	PLEURAL EFFUSION WITH MCC	Medical
No	Yes	187	PLEURAL EFFUSION WITH CC	Medical
No	No	188	PLEURAL EFFUSION WITHOUT CC/MCC	Medical

Pulmonary edema and respiratory failure

All patients who qualify for the subsection Pulmonary edema and respiratory failure will be automatically grouped into DRG 189 - PULMONARY EDEMA AND RESPIRATORY FAILURE.

View the requirements to qualify for this subsection.

DRG	Name	Type
189	PULMONARY EDEMA AND RESPIRATORY FAILURE	Medical

Chronic obstructive pulmonary disease

Patients who qualify for Chronic obstructive pulmonary disease 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	190	CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC	Medical
No	Yes	191	CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC	Medical
No	No	192	CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC	Medical

Simple pneumonia and pleurisy

Patients who qualify for Simple pneumonia and pleurisy 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	193	SIMPLE PNEUMONIA AND PLEURISY WITH MCC	Medical
No	Yes	194	SIMPLE PNEUMONIA AND PLEURISY WITH CC	Medical
No	No	195	SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC	Medical

Interstitial lung disease

Patients who qualify for Interstitial lung disease 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	196	INTERSTITIAL LUNG DISEASE WITH MCC	Medical
No	Yes	197	INTERSTITIAL LUNG DISEASE WITH CC	Medical
No	No	198	INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC	Medical

Pneumothorax

Patients who qualify for Pneumothorax 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	199	PNEUMOTHORAX WITH MCC	Medical
No	Yes	200	PNEUMOTHORAX WITH CC	Medical
No	No	201	PNEUMOTHORAX WITHOUT CC/MCC	Medical

Bronchitis and asthma

Patients who qualify for Bronchitis and asthma 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	202	BRONCHITIS AND ASTHMA WITH CC/MCC	Medical
No	203	BRONCHITIS AND ASTHMA WITHOUT CC/MCC	Medical

Respiratory signs and symptoms

All patients who qualify for the subsection Respiratory signs and symptoms will be automatically grouped into DRG 204 - RESPIRATORY SIGNS AND SYMPTOMS.

View the requirements to qualify for this subsection.

DRG	Name	Type
204	RESPIRATORY SIGNS AND SYMPTOMS	Medical

Other respiratory system diagnoses

Patients who qualify for Other respiratory system diagnoses 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	205	OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC	Medical
No	206	OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT 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.

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