The Medicare Severity Diagnosis-Related Group (MS-DRG) is a classification system used by the Centers for Medicare and Medicaid Services (CMS) to group patients with similar clinical characteristics and resource utilization into a single payment category.
Value
a tibble
Details
The system is primarily used for Medicare reimbursement purposes, but it is also adopted by many other payers as a basis for payment determination.
MS-DRGs are based on the principal diagnosis, up to 24 additional diagnoses, and up to 25 procedures performed during the stay. In a small number of MS-DRGs, classification is also based on the age, sex, and discharge status of the patient.
Hospitals serving more severely ill patients receive increased reimbursements, while hospitals treating less severely ill patients will receive less reimbursement.
Examples
search_msdrg(drg = "011")
#> # A tibble: 1 × 6
#> drg drg_description mdc mdc_description drg_type drg_abbrev
#> <chr> <chr> <chr> <chr> <chr> <chr>
#> 1 011 TRACHEOSTOMY FOR FACE,MOUTH &… NA NA Surgical P
search_msdrg(mdc = "24")
#> # A tibble: 8 × 6
#> drg drg_description mdc mdc_description drg_type drg_abbrev
#> <chr> <chr> <chr> <chr> <chr> <chr>
#> 1 955 CRANIOTOMY FOR MULTIPLE SIGNI… 24 Multiple Signi… Surgical P
#> 2 956 LIMB REATTACHMENT, HIP AND FE… 24 Multiple Signi… Surgical P
#> 3 957 OTHER O.R. PROCEDURES FOR MUL… 24 Multiple Signi… Surgical P
#> 4 958 OTHER O.R. PROCEDURES FOR MUL… 24 Multiple Signi… Surgical P
#> 5 959 OTHER O.R. PROCEDURES FOR MUL… 24 Multiple Signi… Surgical P
#> 6 963 OTHER MULTIPLE SIGNIFICANT TR… 24 Multiple Signi… Medical M
#> 7 964 OTHER MULTIPLE SIGNIFICANT TR… 24 Multiple Signi… Medical M
#> 8 965 OTHER MULTIPLE SIGNIFICANT TR… 24 Multiple Signi… Medical M