MS-DRG v41 (FY 2024) MDC 16 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v41 (FY 2024) Definitions Manual • MDC 16

MDC 16 Diseases and disorders of blood, blood forming organs and immunologic disorders 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 16 Assignment of Diagnosis Codes

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

Splenic Procedures

Patients who qualify for Splenic 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	799	SPLENIC PROCEDURES WITH MCC	Medical
No	Yes	800	SPLENIC PROCEDURES WITH CC	Medical
No	No	801	SPLENIC PROCEDURES WITHOUT CC/MCC	Medical

Other O.R. procedures of the blood and blood forming organs

Patients who qualify for Other O.R. procedures of the blood and blood forming organs 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	802	OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC	Medical
No	Yes	803	OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC	Medical
No	No	804	OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC	Medical

Major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders

Patients who qualify for Major hematological and immunological diagnoses except sickle cell crisis and coagulation 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	808	MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC	Medical
No	Yes	809	MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC	Medical
No	No	810	MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC	Medical

Red blood cell disorders

Patients who qualify for Red blood cell 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	811	RED BLOOD CELL DISORDERS WITH MCC	Medical
No	812	RED BLOOD CELL DISORDERS WITHOUT MCC	Medical

Coagulation disorders

All patients who qualify for the subsection Coagulation disorders will be automatically grouped into DRG 813 - COAGULATION DISORDERS.

View the requirements to qualify for this subsection.

DRG	Name	Type
813	COAGULATION DISORDERS	Medical

Reticuloendothelial and immunity disorders

Patients who qualify for Reticuloendothelial and immunity 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	814	RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC	Medical
No	Yes	815	RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC	Medical
No	No	816	RETICULOENDOTHELIAL AND IMMUNITY DISORDERS 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.