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.
|Rank||DRG code||DRG description||Percent of total DRG diagnoses||Explore dataset|
|1||871||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC||8.4%||Explore|
|2||291||HEART FAILURE & SHOCK W MCC||5.0%||Explore|
|3||177||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC||4.4%||Explore|
|5||193||SIMPLE PNEUMONIA & PLEURISY W MCC||1.6%||Explore|
|6||189||PULMONARY EDEMA & RESPIRATORY FAILURE||1.4%||Explore|
|7||872||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC||1.3%||Explore|
|8||853||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC||1.3%||Explore|
|9||682||RENAL FAILURE W MCC||1.3%||Explore|
|10||280||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC||1.3%||Explore|
|11||378||G.I. HEMORRHAGE W CC||1.1%||Explore|
|12||683||RENAL FAILURE W CC||1.1%||Explore|
|13||690||KIDNEY & URINARY TRACT INFECTIONS W/O MCC||1.1%||Explore|
|14||640||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC||1.1%||Explore|
|15||392||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC||1.1%||Explore|
|16||64||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC||1.0%||Explore|
|17||698||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC||1.0%||Explore|
|18||689||KIDNEY & URINARY TRACT INFECTIONS W MCC||1.0%||Explore|
|19||57||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC||1.0%||Explore|
|20||65||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC||1.0%||Explore|
|21||377||G.I. HEMORRHAGE W MCC||0.9%||Explore|
|22||470||MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC||0.9%||Explore|
|23||190||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC||0.9%||Explore|
|24||641||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC||0.8%||Explore|
|25||309||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC||0.8%||Explore|
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:
- Principal diagnosis
- Secondary diagnoses
- Patient age and sex
- Discharge status
- Comorbidities and complications
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)
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