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Top DRG Codes by Diagnosis Volume

Diagnostic Related Groups (DRGs)  are primarily used to determine reimbursement for inpatient stays. Every inpatient visit is placed into one DRG category based on the patient’s primary diagnosis, procedures performed, and discharge status.

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

Top 25 Diagnosis Related Groups by Total Diagnoses

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DRG CodeDescriptionPrimary DiagnosesSecondary DiagnosesTotal DiagnosesExplore These Claims
871SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS WITH MAJOR COMPLICATIONS OR COMORBIDITIES1,561,76830,073,94431,635,712Explore This Code
291HEART FAILURE & SHOCK WITH MAJOR COMPLICATIONS OR COMORBIDITIES856,93917,434,94018,291,879Explore This Code
885PSYCHOSES1,747,93810,822,35012,570,288Explore This Code
470MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES1,243,48210,604,41811,847,901Explore This Code
189PULMONARY EDEMA & RESPIRATORY FAILURE401,1167,222,0327,623,148Explore This Code
193SIMPLE PNEUMONIA & PLEURISY WITH MAJOR COMPLICATIONS OR COMORBIDITIES521,9866,902,4697,424,455Explore This Code
872SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV 96 OR MORE HOURS WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES413,6606,680,6997,094,359Explore This Code
683RENAL FAILURE WITH COMPLICATIONS OR COMORBIDITIES327,0715,860,0826,187,153Explore This Code
190CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MAJOR COMPLICATIONS OR COMORBIDITIES334,2835,748,8946,083,178Explore This Code
392ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES583,5585,278,9625,862,520Explore This Code
378G.I. HEMORRHAGE WITH COMPLICATIONS OR COMORBIDITIES328,2155,268,8275,597,042Explore This Code
682RENAL FAILURE WITH MAJOR COMPLICATIONS OR COMORBIDITIES270,4315,276,6325,547,063Explore This Code
690KIDNEY & URINARY TRACT INFECTIONS WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES371,8925,058,3905,430,282Explore This Code
853INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH MAJOR COMPLICATIONS OR COMORBIDITIES238,4475,177,6415,416,088Explore This Code
194SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATIONS OR COMORBIDITIES419,6624,724,1755,143,837Explore This Code
065INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATIONS OR COMORBIDITIES291,9244,114,0654,405,989Explore This Code
280ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MAJOR COMPLICATIONS OR COMORBIDITIES230,7964,092,1504,322,946Explore This Code
057DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES262,0004,016,2854,278,286Explore This Code
603CELLULITIS WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES399,9443,859,8734,259,817Explore This Code
064INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MAJOR COMPLICATIONS OR COMORBIDITIES230,4073,854,1194,084,526Explore This Code
292HEART FAILURE & SHOCK WITH COMPLICATIONS OR COMORBIDITIES232,1053,842,2114,074,316Explore This Code
177RESPIRATORY INFECTIONS & INFLAMMATIONS WITH MAJOR COMPLICATIONS OR COMORBIDITIES191,1533,603,7343,794,887Explore This Code
689KIDNEY & URINARY TRACT INFECTIONS WITH MAJOR COMPLICATIONS OR COMORBIDITIES205,7403,527,7873,733,527Explore This Code
640MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH MAJOR COMPLICATIONS OR COMORBIDITIES211,1283,501,9013,713,029Explore This Code
641MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT MAJOR COMPLICATIONS OR COMORBIDITIES257,7583,403,9703,661,729Explore This Code


Fig. 1 Data from Definitive Healthcare’s Hospitals and IDNs database. Annual Medicare Data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAF). Data from calendar year 2018 (most recent complete data set available). Accessed June 2020.

The most common diagnosis by hospital admissions volume is septicemia, followed by heart failure and shock in second, and then psychoses in third. In 2018, diagnoses for septicemia reached an approximate 31.6 million, 30 million of which were secondary diagnoses.

Definitive Healthcare’s claims data shows that total diagnoses of heart failure and shock increased substantially since 2016, where it previously ranked as the fourth highest diagnosis by volume — 11.6 million in 2016 vs. 18.2 million in 2018.

Psychoses saw 12.5 million total diagnoses in 2018, on par with previous years. Part of the reason for the consistently high psychoses volumes is the definition of the DRG itself. Its subcategories include multiple types of severe mental illnesses that can require inpatient treatment, such as schizophrenia, bipolar disorder with manic episodes, and severe depression.

 

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