Healthcare Insights

Top 25 DRGs by diagnosis volume

Diagnosis-Related Groups (DRGs) are used to categorize patients and reflect Medicare fees and reimbursement for hospital stays. Patients are placed into a DRG category based on their primary diagnosis, procedures performed, and discharge status. DRGs ensure that Medicare reimbursements reflect a hospital’s case-mix complexity, or the types and severity of patients they most often treat.

The Definitive Healthcare HospitalView product tracks Medicare inpatient procedures for more than 5,200 U.S. hospitals. DRGs are provided through the Medicare Standard Analytic Files (SAF). Complete calendar year data is typically released each fall for the preceding year. Below, we list the DRGs by total volume for January 2022 to June 2022.

Top DRGs by total diagnoses

RankDRG codeDRG descriptionPercent of total DRG diagnosesExplore dataset
1871SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC8.4%Explore
2291HEART FAILURE & SHOCK W MCC5.0%Explore
3177RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC4.4%Explore
4885PSYCHOSES1.7%Explore
5193SIMPLE PNEUMONIA & PLEURISY W MCC1.6%Explore
6189PULMONARY EDEMA & RESPIRATORY FAILURE1.4%Explore
7872SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC1.3%Explore
8853INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC1.3%Explore
9682RENAL FAILURE W MCC1.3%Explore
10280ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC1.3%Explore
11378G.I. HEMORRHAGE W CC1.1%Explore
12683RENAL FAILURE W CC1.1%Explore
13690KIDNEY & URINARY TRACT INFECTIONS W/O MCC1.1%Explore
14640MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC1.1%Explore
15392ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC1.1%Explore
1664INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC1.0%Explore
17698OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC1.0%Explore
18689KIDNEY & URINARY TRACT INFECTIONS W MCC1.0%Explore
1957DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC1.0%Explore
2065INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC1.0%Explore
21377G.I. HEMORRHAGE W MCC0.9%Explore
22470MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC0.9%Explore
23190CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC0.9%Explore
24641MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC0.8%Explore
25309CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC0.8%Explore

Fig. 1. Data from Definitive Healthcare HospitalView product and sourced from the 2022 Medicare Quarterly Standard Analytic Files (SAF) for January 2022 to June 2022. Accessed January 2023.

What are the most common DRGs?

The most common DRG is septicemia, or sepsis, with more than 8% of diagnoses. Sepsis is also a top infectious disease. Heart failure is the second top DRG code, followed by respiratory infections and inflammations.

How is a DRG calculated?

Each DRG is given a weighted value relative to the time and resources required to administer care for the average patient effectively. This value is multiplied by a preset dollar amount that reflects the hospital’s status (for example, teaching hospitals have higher reimbursements) and service area demographics (such as average local wage levels) to find the total reimbursement amount.

DRG assignment is based on:

What is an MS-DRG?

The Medicare Severity DRG (MS-DRG) system further differentiates each patient’s severity of illness and associated care costs. The original DRG case-mix system was limited to one or two levels of severity, while most MS-DRGs have three levels of severity. This allows hospitals to assess a patient’s needs more accurately without fear of hampering reimbursement.

MS-DRG severity categories include:

  • Complication/comorbidity (CC)
  • Major complication/comorbidity (MMC)
  • Non-complication/comorbidity (Non-CC)

Learn more

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