MS-DRG v41 (FY 2024) MDC 23 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v41 (FY 2024) Definitions Manual • MDC 23

MDC 23 Factors influencing health status and other contacts with health services 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 23 Assignment of Diagnosis Codes

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

O.R. procedures with diagnoses of other contact with health services

Patients who qualify for O.R. procedures with diagnoses of other contact with health services 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	939	O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC	Medical
No	Yes	940	O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC	Medical
No	No	941	O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC	Medical

Rehabilitation

Patients who qualify for Rehabilitation 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	945	REHABILITATION WITH CC/MCC	Medical
No	946	REHABILITATION WITHOUT CC/MCC	Medical

Signs and symptoms

Patients who qualify for Signs and symptoms 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	947	SIGNS AND SYMPTOMS WITH MCC	Medical
No	948	SIGNS AND SYMPTOMS WITHOUT MCC	Medical

Aftercare

Patients who qualify for Aftercare 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	949	AFTERCARE WITH CC/MCC	Medical
No	950	AFTERCARE WITHOUT CC/MCC	Medical

Other factors influencing health status

All patients who qualify for the subsection Other factors influencing health status will be automatically grouped into DRG 951 - OTHER FACTORS INFLUENCING HEALTH STATUS.

View the requirements to qualify for this subsection.

DRG	Name	Type
951	OTHER FACTORS INFLUENCING HEALTH STATUS	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.