Top 10 MS-DRG Shifts

on Tuesday, 23 July 2013. All News Items | Documentation | Coding

The CMS ICD-10 website contains information on the ICD-10 MS-DRG Conversion Project. An article, “Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments”, updated 2/25/13, lists the top 10 MS-DRGs that shift to another DRG when re-coded with ICD-10. Below are 4 of the 10 most significant MS-DRG changes:

  1. MS-DRG 812, Red Blood Cell Disorders without MCC
    Sequencing Anemia as the principal diagnosis under ICD-9 groups these cases to MS-DRG 812. However, the ICD-10-CM guideline states to sequence the appropriate code for the malignancy as the principal or first-listed diagnosis followed by code D63.0, Anemia in Neoplastic Disease. Sequencing the malignancy first under ICD-10 usually will group these cases to a higher-weighted MS-DRG related to cancer.
  2. MS-DRG 391, Esophagitis, Gastroenteritis & Miscellaneous Digestive Disorders with MCC
    Under ICD-9, Esophageal Hemorrhage has its own unique code, 530.82 and groups to MS-DRG 368 (with the addition of an MCC).  Also, ICD-9 code 530.89, Other Disorders of Esophagus, groups to MS-DRG 391 (with the addition of an MCC). Code 530.89, which is not an MCC, is the closest match to the ICD-10 code, K22.8, Other Diseases of Esophagus which includes esophageal hemorrhage in its definition and is the cause of about 90% of the weight change. A record without an MCC will shift to a lower-weighted MS-DRG.
  3. MS-DRG 885, Psychoses
    ICD-9 cases that have code 296.20, Major Depression, Single Episode, Unspecified sequenced as the principal diagnosis groups to MS-DRG 885, Psychoses. Under ICD-10, this same diagnosis is assigned to F32.9, which includes Depression NOS. This will group the case to a lower-weighted MS-DRG 881, Depressive Neuroses.
  4. MS-DRG 191, Chronic Obstructive Pulmonary Disease with CC
    Under ICD-9, code 491.21, Acute Exacerbation of COPD can be further specified to:
    • COPD with Acute Bronchitis, 491.22
    • COPD with Acute Exacerbation of Asthma, 493.22

    Under ICD-9, all of these codes are listed as CCs. Cases will group to MS-DRG 191, Chronic Obstructive Pulmonary Disease with CC when either condition above is sequenced as the principal diagnosis followed by one of the other conditions listed above as a secondary diagnosis.

Under ICD-10, one code, J44.1, COPD with Acute Exacerbation includes chronic obstructive bronchitis, chronic obstructive asthma, and chronic obstructive pulmonary disease in its description. Therefore, the same scenario above will group to a lower-weighted MS-DRG 192, Chronic Obstructive Pulmonary Disease without CC/MCC in ICD-10 because these additional conditions will not be coded separately.

Article by Anita Meyers

Anita Meyers, RHIT, CCS, AHIMA-approved ICD-10 Trainer is an Inpatient Coding Professional at Medical Management Plus, Inc. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP, Inc. team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus, Inc. You may contact Anita at This email address is being protected from spambots. You need JavaScript enabled to view it.
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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