MS-DRG v41 (FY 2024) MDC 06 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v41 (FY 2024) Definitions Manual • MDC 06

MDC 06 Diseases and disorders of the digestive 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 06 Assignment of Diagnosis Codes

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

Stomach, esophageal and duodenal procedures

Patients who qualify for Stomach, esophageal and duodenal 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	326	STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC	Medical
No	Yes	327	STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC	Medical
No	No	328	STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC	Medical

Major small and large bowel procedures

Patients who qualify for Major small and large bowel 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	329	MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC	Medical
No	Yes	330	MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC	Medical
No	No	331	MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC	Medical

Rectal resection

Patients who qualify for Rectal resection 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	332	RECTAL RESECTION WITH MCC	Medical
No	Yes	333	RECTAL RESECTION WITH CC	Medical
No	No	334	RECTAL RESECTION WITHOUT CC/MCC	Medical

Peritoneal adhesiolysis

Patients who qualify for Peritoneal adhesiolysis 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	335	PERITONEAL ADHESIOLYSIS WITH MCC	Medical
No	Yes	336	PERITONEAL ADHESIOLYSIS WITH CC	Medical
No	No	337	PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC	Medical

Appendix Procedures

Patients who qualify for Appendix 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	397	APPENDIX PROCEDURES WITH MCC	Medical
No	Yes	398	APPENDIX PROCEDURES WITH CC	Medical
No	No	399	APPENDIX PROCEDURES WITHOUT CC/MCC	Medical

Minor small and large bowel procedures

Patients who qualify for Minor small and large bowel 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	344	MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC	Medical
No	Yes	345	MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC	Medical
No	No	346	MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC	Medical

Anal and stomal procedures

Patients who qualify for Anal and stomal 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	347	ANAL AND STOMAL PROCEDURES WITH MCC	Medical
No	Yes	348	ANAL AND STOMAL PROCEDURES WITH CC	Medical
No	No	349	ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC	Medical

Hernia procedures

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

Inguinal and Femoral	MCC	CC	DRG	Name	Type
Yes	Yes	n/a	350	INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC	Medical
Yes	No	Yes	351	INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC	Medical
Yes	No	No	352	INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC	Medical
No	Yes	n/a	353	HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC	Medical
No	No	Yes	354	HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC	Medical
No	No	No	355	HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC	Medical

Other digestive system O.R. procedures

Patients who qualify for Other digestive 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	356	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC	Medical
No	Yes	357	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC	Medical
No	No	358	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC	Medical

Major esophageal disorders

Patients who qualify for Major esophageal disorders 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	368	MAJOR ESOPHAGEAL DISORDERS WITH MCC	Medical
No	Yes	369	MAJOR ESOPHAGEAL DISORDERS WITH CC	Medical
No	No	370	MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC	Medical

Major gastrointestinal disorders and peritoneal infections

Patients who qualify for Major gastrointestinal disorders and peritoneal infections 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	371	MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC	Medical
No	Yes	372	MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC	Medical
No	No	373	MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC	Medical

Digestive malignancy

Patients who qualify for Digestive 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	374	DIGESTIVE MALIGNANCY WITH MCC	Medical
No	Yes	375	DIGESTIVE MALIGNANCY WITH CC	Medical
No	No	376	DIGESTIVE MALIGNANCY WITHOUT CC/MCC	Medical

Gastrointestinal hemorrhage

Patients who qualify for Gastrointestinal hemorrhage 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	377	GASTROINTESTINAL HEMORRHAGE WITH MCC	Medical
No	Yes	378	GASTROINTESTINAL HEMORRHAGE WITH CC	Medical
No	No	379	GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC	Medical

Peptic ulcer

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

Complicated	MCC	CC	DRG	Name	Type
Yes	Yes	n/a	380	COMPLICATED PEPTIC ULCER WITH MCC	Medical
Yes	No	Yes	381	COMPLICATED PEPTIC ULCER WITH CC	Medical
Yes	No	No	382	COMPLICATED PEPTIC ULCER WITHOUT CC/MCC	Medical
No	Yes	n/a	383	UNCOMPLICATED PEPTIC ULCER WITH MCC	Medical
No	No	n/a	384	UNCOMPLICATED PEPTIC ULCER WITHOUT MCC	Medical

Inflammatory bowel disease

Patients who qualify for Inflammatory bowel 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	385	INFLAMMATORY BOWEL DISEASE WITH MCC	Medical
No	Yes	386	INFLAMMATORY BOWEL DISEASE WITH CC	Medical
No	No	387	INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC	Medical

Gastrointestinal obstruction

Patients who qualify for Gastrointestinal obstruction 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	388	GASTROINTESTINAL OBSTRUCTION WITH MCC	Medical
No	Yes	389	GASTROINTESTINAL OBSTRUCTION WITH CC	Medical
No	No	390	GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC	Medical

Esophagitis, gastroenteritis and miscellaneous digestive disorders

Patients who qualify for Esophagitis, gastroenteritis and miscellaneous digestive disorders 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	391	ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC	Medical
No	392	ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC	Medical

Other digestive system diagnoses

Patients who qualify for Other digestive 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	CC	DRG	Name	Type
Yes	n/a	393	OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC	Medical
No	Yes	394	OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC	Medical
No	No	395	OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC	Medical

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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.

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