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How Your DRG Is Determined

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Medicare and many health insurance companies pay hospitals using DRGs, or diagnostic related groupings . This means the hospital gets paid based on the admitted patient’s diagnosis and prognosis, rather than based on what it actually spent caring for the hospitalized patient.

This article will explain how DRGs are determined and how this affects your medical bills.

If a hospital can treat a patient while spending less money than the DRG payment for that illness, the hospital makes a profit. If, while treating the hospitalized patient, the hospital spends more money than the DRG payment, the hospital will lose money on that patient’s hospitalization. This is meant to control healthcare costs by encouraging the efficient care of hospitalized patients.

Why You Should Care How a DRG Is Determined

If you’re a patient, understanding the basics of what factors impact your DRG assignment can help you better understand your hospital bill, what your health insurance company or Medicare is paying for, or why you’ve been assigned a particular DRG.

If you’re a physician rather than a patient, understanding the process of assigning a DRG can help you understand how your documentation in the medical record impacts the DRG and what Medicare will reimburse for a given patient’s hospitalization. It will also help you understand why the coders and compliance personnel ask you the questions they ask.

Steps for Determining a DRG

This is a simplified run-down of the basic steps a hospital’s coder uses to determine the DRG of a hospitalized patient. This isn’t exactly how the coder does it; in the real world, coders have a lot of help from software.

• Determine the principal diagnosis for the patient’s admission.
• Determine whether or not there was a surgical procedure.
• Determine if there were any secondary diagnoses that would be considered comorbidities or could cause complications. A comorbid condition is an additional medical problem happening at the same time as the principal medical problem. It might be a related problem, or totally unrelated.

These steps are illustrated in a flow chart on page 15 of this CMS document . The DRG will also reflect various nuances related to the patient's healthcare needs, including the severity of the condition, the prognosis, how difficult or intensive the treatment is, and the resources necessary to treat the patient.

Let’s say elderly Mrs. Gomez comes to the hospital with a broken femoral neck, known more commonly as a broken hip . She requires surgery and undergoes a total hip replacement . While she’s recovering from her hip surgery, her chronic heart problem flares up and she develops acute systolic congestive heart failure . Eventually, her physicians get Mrs. Gomez’s heart failure under control, she’s healing well, and she’s discharged to an inpatient rehab facility for intensive physical therapy before going back home.

Mrs. Gomez’s principal diagnosis would be a fracture of the neck of the femur. Her surgical procedure is related to her principal diagnosis and is a total hip replacement. Additionally, she has a major comorbid condition: acute systolic congestive heart failure.

When the coder plugs all of this information into the software, the software will spit out a DRG of 469 , entitled “Major Joint Replacement or Reattachment of Lower Extremity With MCC.” The "MCC" stands for "major complication or comorbidity" and it's applicable in this case because of the cardiovascular problems that Mrs. Gomez experienced during her hospital stay.

More About Step 1: Principal Diagnosis

The most important part of assigning a DRG is getting the correct principal diagnosis. This seems simple but can be tough, especially when a patient has several different medical problems going on at the same time. According to the Centers for Medicare and Medicaid Services (CMS), “The principal diagnosis is the condition established after study to be chiefly responsible for the admission.”

The principal diagnosis must be a problem that was present when you were admitted to the hospital; it can’t be something that developed after your admission. This can be tricky since sometimes your physician doesn’t know what’s actually wrong with you when you’re admitted to the hospital.

For example, maybe you’re admitted to the hospital with abdominal pain, but the doctor doesn’t know what’s causing the pain. It takes her a bit of time to determine that you have colon cancer and that colon cancer is the cause of your pain. Since the colon cancer was present on admission, even though the physician didn’t know what was causing the pain when you were admitted, colon cancer can be assigned as your principal diagnosis.

There are also times when a patient is admitted to the hospital with two or more conditions that each meet the definition of principal diagnosis. There are protocols in place that the doctor and coders use to ensure that the conditions are actually equally qualified to be the principal diagnosis, but if they are, both conditions are coded but either one can be selected as the principal diagnosis.

More About Step 2: Surgical Procedure

Although this seems cut and dry, like most things about health insurance and Medicare, it’s not. There are a couple of rules that determine if and how a surgical procedure impacts a DRG.

First, Medicare defines what counts as a surgical procedure for the purposes of assigning a DRG, and what doesn’t count as a surgical procedure. Some things that seem like surgical procedures to the patient having the procedure don’t actually count as a surgical procedure when assigning your DRG.

Second, it’s important to know whether the surgical procedure in question is in the same major diagnostic category as the principal diagnosis. Every principal diagnosis is part of a major diagnostic category, roughly based on body systems.

If Medicare considers your surgical procedure to be within the same major diagnostic category as your principal diagnosis, your DRG will be different than if Medicare considers your surgical procedure to be unrelated to your principal diagnosis. In the above example with Mrs. Gomez, Medicare considers the hip replacement surgery and the fractured hip to be in the same major diagnostic category.

More About Step 3: Comorbid Conditions and Complications

Since it uses more resources and likely costs more to care for a patient like Mrs. Gomez who has both a broken hip and acute congestive heart failure than it does to care for a patient with a broken hip and no other problems, the DRG protocol takes this into account.

A comorbidity is a condition that existed before admission, and a complication is any condition that occurred after admission, not necessarily a complication of care.  

Medicare even distinguishes between major comorbid conditions like acute congestive heart failure or sepsis, and not-so-major comorbid conditions like an acute flare-up of chronic COPD. This is because major comorbid conditions require more resources to treat than not-so-major comorbid conditions do. In cases like this, there may be three different DRGs, known as a DRG triplet:

• A lower-paying DRG for the principal diagnosis without any comorbid conditions or complications.
• A medium-paying DRG for the principal diagnosis with a not-so-major comorbid condition. This is known as a DRG with a CC or a comorbid condition.
• A higher-paying DRG for the principal diagnosis with a major comorbid condition, known as a DRG with an MCC or major comorbid condition.

If you’re a physician getting questions from the coder or the compliance department, many of these questions will be aimed at determining if the patient was being treated for a CC or MCC during his or her hospital stay in addition to being treated for the principal diagnosis.

If you’re a patient looking at your bill or explanation of benefits and your health insurance company pays for hospitalizations based on the DRG payment system, you’ll see this reflected in the title of the DRG you were assigned.

A DRG title that includes “with MCC” or “with CC” means that, in addition to treating the principal diagnosis you were admitted for, the hospital also used its resources to treat a comorbid condition during your hospitalization. The comorbid condition likely increased the resources the hospital had to use to treat you, which is why the hospital was paid more than they would have received if you'd only had a single diagnosis and no comorbid conditions.

Hospital Base Rates and DRG Relative Weights

DRGs are assigned a relative "weight," which reflects how resource-intensive it is to treat the patient. The average weight is 1.0. DRGs with weights above 1 require more resources, while DRGs with weights below 1 are, in general, less costly to treat.

In addition, each hospital has a base rate, which is determined based on factors such as location (labor and overhead costs are higher in some areas than in others), whether it's a teaching hospital, whether it's in a rural and/or underserved area, and the percentage of uninsured patients the hospital sees.

The DRG's relative weight and the hospital's base rate are both included int the formula that determines how much the hospital will get paid.

When a Medicare patient is hospitalized, a diagnostic-related category (DRG) code is assigned based on the patient's condition (private insurers can also use DRGs or similar coding protocols). DRGs are based on the patient's principal diagnosis (ie, the primary reason they're admitted to the hospital), any surgical procedures, and any comorbidities that complicate the treatment or add to the resources needed to care for the patient.

DRGs are assigned a relative weight, reflecting how costly/resource intensive the treatment is. And hospitals also have different base rates, reflecting various factors that impact their overhead costs.

The DRG and the hospital's base rate are both taken into account during the billing and payment process, and are used to determine how much the hospital will be paid. The patient's share of the bill will generally depend on the specifics of their health plan and whether they have supplemental coverage.

A Word From Verywell

Although the DRG determination process is complex, you don't have to know the details of exactly how it works. As far as the patient is concerned, the important details include using an in-network hospital and understanding how your health plan's  cost-sharing  works (deductible, coinsurance, and out-of-pocket maximum are the factors that generally come into play with inpatient care). And if you have Medicare and are going to need follow-up care in a skilled nursing facility, you'll also want to understand the difference between inpatient and observation care .

ACP Hospitalist and American College of Physicians. The ABCs of DRGs .

Centers for Medicare and Medicaid Services.  Design and development of the Diagnosis Related Group (DRG) .

Department of Health and Human Services. Centers for Medicare and Medicaid Services. CMS manual system. pub. 100-04: medicare claims processing .

Williams, Lee. AAPC. Determine the Principal Diagnosis Code in the Inpatient Setting . January 2, 2019.

Centers for Medicare and Medicaid Services. ICD-10-CM/PCS MS-DRG v37.0 Definitions Manual .

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

Mastering MS-DRG Assignments to Enhance Reimbursements

Executives of hospital management often overlook medical coding as a contributing factor to the revenue cycle – but it’s a crucial link between earning well-deserved reimbursements from the services performed. One such revenue-defining coding system is the Medicare Severity Diagnosis Related Group (MS-DRG), which utilizes ICD-10 diagnosis and procedure codes , and other factors, such as age, sex, and discharge disposition, to facilitate payment for Inpatient services. In this introduction to MS-DRG assignments, we’ll explore examples of DRGs and introduce invaluable resources for selecting the correct DRG, including a DRG list and DRG assignment software.

What is Medicare Severity Diagnosis Related Group (MS-DRG) Coding?

MS-DRG is a sophisticated classification system that holds the power to categorize patients and their medical cases based on clinical characteristics and the resources required for their care (CMS, 2023). Each patient’s case is assigned a specific DRG, encapsulating diagnoses, procedures, age, sex, MCCs, CCs, and other relevant factors. These codes effectively communicate the complexity and intensity of services provided, determining reimbursement levels for hospital stays. Introduced by the Centers for Medicare and Medicaid Services (CMS), this system streamlines the payment process for Inpatient services.

It serves as a universal language, allowing healthcare providers to effectively communicate the complexity and intensity of services rendered. By assigning specific DRGs to patient cases, hospitals can accurately capture the intricacies of each scenario, leading to fair reimbursement and improved financial outcomes.

Accurate DRG assignment plays a pivotal role in directly impacting a hospital’s or facility’s reimbursements and revenue cycle. Accurate and appropriate DRG assignment ensures that the severity and complexity of each patient case are effectively communicated, leading to proper reimbursement for the resources invested in their care. By assigning the correct DRG, hospitals can optimize their revenue potential by capturing the true value of the services provided.

Additionally, accurate DRG assignment helps healthcare organizations navigate complex payment structures and regulatory guidelines, reducing the risk of undercoding or overcoding, which can result in financial penalties or revenue loss. A streamlined and efficient revenue cycle relies heavily on accurate DRG assignment, ensuring that hospitals receive fair and adequate reimbursements for the care they deliver while maintaining financial stability and sustainability.

DRG Examples

To grasp the practical application of DRG assignments, let’s explore some examples.

Patient admitted with the principal diagnosis of acute myocardial infarction is impacted when a percutaneous cardiovascular procedure is performed with drug-eluting or non-drug eluting stents or arteries.

DRG 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS DRG 247 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITHOUT MCC DRG 248 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS DRG 249 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH NON-DRUG-ELUTING STENT WITHOUT MCC

MDC 05 Disease and Disorders of the Circulatory System

Percutaneous Cardiovascular Procedures with Coronary Artery/Stent Decision Tree

Patient admitted with the principal diagnosis of acute myocardial infarction is impacted when the patient has a major complication or comorbidity (MCC) or complication and comorbidity (CC) or not and whether the patient was discharged alive or expired.

DRG 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC DRG 281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC DRG 282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC DRG 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC DRG 284 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC DRG 285 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Acute Myocardial Infarction and Principal Diagnosis Decision Tree

Patient admitted with the principal diagnosis of pneumonia is impacted when the patient has a major complication or comorbidity (MCC) or complication and comorbidity.

DRG 193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC DRG 194 SIMPLE PNEUMONIA AND PLEURISY WITH CC DRG 195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

MDC 04 Diseases and Disorder of the Respiratory System

Simple Pneumonia as the Principal Diagnosis Decision Tree

DRG Resources

Here are several DRG resources to assist with appropriate assignment:

MS-DRG List:  This comprehensive DRG list from CMS includes  a vast range of codes  representing various medical cases, diagnoses, procedures, and patient profiles. This list enables healthcare providers to accurately assign the most suitable DRG, streamlining the reimbursement process and optimizing financial outcomes.

MS-DRG Grouper Software : An invaluable tool in correctly assigning DRGs is the MS-DRG Grouper software. The software calculates payments to cover the costs of an Inpatient encounter. The coder enters the ICD-10-CM/PCS codes into the software, and it calculates the MS-DRG based on those codes the user has selected. The MS-DRG payment equals the MS-DRG relative weight multiplied by the hospital blended rate.

Utilize Our Coding Support Services to Assign DRGs & Optimize Revenue

YES offers expert coding support services for DRG assignment, designed to streamline providers’ processes, ensure compliance, and maximize revenue potential. Here’s why you should choose our services:

• Expertise and Experience : Our highly skilled team of certified coding professionals possesses extensive knowledge and experience in coding and assigning DRGs. We remain current with the latest industry regulations and guidelines, guaranteeing accurate and comprehensive coding to maximize reimbursements.
• Compliance and Audit Readiness : We recognize the importance of compliance in healthcare. Our services ensure that your coding practices align with regulatory guidelines, safeguarding your organization from penalties and preparing you for any compliance audits.
• Revenue Optimization : By leveraging our DRG assignment and coding support services, you unlock the full revenue potential of your organization. Utilizing our customized trending reports, we identify areas for improvement, minimize coding errors, and provide actionable insights to enhance financial performance.

Mastering DRG assignment is essential for hospitals and healthcare organizations to achieve optimal reimbursements and operational efficiency.  Contact us today  to discuss how our  coding support services  can elevate your coding practices and drive superior outcomes.

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Q&a: identifying the ms-drg for unreleated surgical procedures.

Q:   Could you please explain unrelated surgical procedure DRGs? For example, a patient with a principal diagnosis of pneumonia whose surgical procedure transurethral resection of the prostate (TURP), MS-DRG 168. Also can you explain how we can differentiate between extensive operating room (OR) procedure and non-extensive OR procedure.

A:  Many CDI specialists with a clinical background are what I like to call, encoder dependent. What I mean by that is we’ve been trained to “code” using an encoder and create our working MS-DRGs based on “grouper” software. It is often helpful to understand how to manually assign a MS-DRG. The basics steps for assigning a MS-DRG are as follows:

• Identify all the applicable diagnoses in the health record
• Identify the principal diagnosis (the condition after study to be chiefly responsible for occasioning the admission)
• Determine its associated ICD code (we currently use ICD-9-CM, but we’ll eventually use ICD-10-CM)
• Identify the base/medical DRG noting its Major Diagnostic Category/body system
• Identify any/all procedures

This is where it can get a little tricky. The UHDDS (Uniform Hospital Discharge Data set) defines the principal procedure as

• One that was performed for definitive treatment, rather than one performed for diagnostic or exploratory purposes, or was necessary to take care of a complication
• If there appear to be two procedures that are principal, then the one most related to the principal diagnosis should be selected as the principal procedure

If there was a procedure performed take the following steps:

• Determine the associated procedure codes (currently based on ICD-9-CM Vol. 3 codes and soon to be ICD-10-PCS) and determine if the procedure code associated with the principal procedure as listed in the DRG Expert?
• If the code isn’t in the DRG Expert index of procedures, it is for one of two reasons: Either it is not a “reimbursable” procedure (i.e., one that will affect the MS-DRG assignment) or is it a major OR procedure
• If there isn’t a procedure or it doesn’t impact DRG assignment, does the medical DRG allow for movement i.e., can patients be put into different groups based on the presence or absence of a complicating condition (CC) or major complicating condition (MCC)
• If so, check to see if any of the remaining diagnoses, which are now considered “secondary diagnoses” are CCs or MCCs
• Finalize the working DRG
• If the procedure code is in the same MDC/body system as the principal diagnosis assign the new surgical MS-DRG (this is the most common scenario and is often referred to as a “match”)
• If the procedure code is not in the same MDC/body system a different process is used to assign the surgical MS-DRG

The MS-DRG system is based on the assumption that if there is a “reimbursable” medical intervention/procedure that the case/claim will remain in the same body system (MDC) as the principal diagnosis will apply. However, there are occasions when the principal procedure is not related to the principal diagnoses because it is associated with a different MDC/body system as in the example you describe, which will require you to take some additional steps, including:

• Turn to the start of “DRGs Associated with All MDCs.”
• Scan the procedure codes listed under  DRG 984 Prostatic O.R. Procedure Unrelated to PDX to try to locate the applicable procedure code.  These are codes that range from 60.0 to 60.99 within ICD-9-CM Vol. 3. If the applicable code is found under DRG 984 then the case will fall within a DRG referred to as a “triplet” where either a CC or a MCC can “move” the DRG. Check the remaining diagnoses codes to see if any are classified as a CC or MCC and finalize the working DRG based on the value of the applicable secondary diagnoses resulting in a final DRG between 986 and 984

Your example of a principal diagnosis of pneumonia (respiratory system MDC) with a procedure of a TURP will fall into one of these DRGs because the TURP is not a procedure located within the respiratory MDC/body system, but is classified as a prostate procedure and found under DRG 984. Your final MS-DRG assignment will depend on the presence or absence of secondary diagnose classified as a CC or MCC.

If the procedure code is not found under DRG 984, scan the procedure codes listed under  DRG 987 Nonextensive O.R. Procedure Unrelated to PDX  to try to locate the applicable procedure code. These codes span several pages within the DRG Expert. If the applicable code is found under DRG 987 then the case will fall within a DRG referred to as a “triplet” where either a CC or a MCC can “move” the DRG. Check the remaining diagnoses codes to see if any are classified as a CC or MCC and finalize the working DRG based on the value of the applicable secondary diagnoses resulting in a final DRG between 987 and 989.

If the procedure code is not found under DRG 984 or DRG 987 and it was not associated with a page when referencing a procedure index or if it was found,  it  was in a different MDC/body system than the PDX then the assumption is the case/claim belongs in DRGs 981-983. This final step requires a leap of faith since it is based on a process of elimination where this is the “last resort” for DRG assignment. These DRGs are heavily scrutinized by external auditors as assignment within these DRGs can erroneously inflate reimbursement if the case was improperly assigned. As above, this is a DRG is a “triplet” where either a CC or a MCC can “move” the DRG. So check the remaining diagnoses codes to see if any are classified as a CC or MCC and finalize the working DRG based on the value of the applicable secondary diagnoses.

Editor’s Note:  Cheryl Ericson, MS, RN, CCDS, CDIP, answered this question. At the time of this article's original release, she was the CDI Education Director for HCPro Inc.

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MS-DRG Classifications and Software

Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the IPPS based on appropriate weighting factors assigned to each DRG.  Therefore, under the IPPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital's payment rate per case by the weight of the DRG to which the case is assigned.  Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs.

Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption.  Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually.  These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources.

Currently, cases are classified into Medicare Severity Diagnosis Related Groups (MS-DRGs) for payment under the IPPS based on the following information reported by the hospital: 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.  Effective October 1, 2015, the diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).

For additional information on the MS-DRG system, including yearly reviews and changes to the MS-DRGs, please view prior Inpatient Prospective Payment System (IPPS) proposed and final rules located in the left navigational area of this page.

Any MS-DRG related inquiries should be sent to the  [email protected] mailbox. 

PROCESS FOR REQUESTING ANNUAL MS-DRG CLASSIFICATION CHANGES

Effective April 5, 2022, the new electronic intake system, Medicare Electronic Application Request Information System TM (MEARIS TM ), became available as an initial release for users to begin gaining familiarity with a new approach and process to submit MS-DRG classification change requests. MEARIS TM , including the mechanism for submitting MS-DRG classification change requests, can be accessed at: https://mearis.cms.gov .

Accordingly, beginning with the FY 2024 MS-DRG classification change requests, CMS will now only accept such requests submitted via MEARIS TM . Request for annual MS-DRG classification changes submitted through the [email protected] mailbox will no longer be considered.

Latest News

ICD-10 MS-DRGs V41.1 Effective April 1, 2024 (PDF)

ICD-10 MS-DRGs V40.1 Effective April 1, 2023 (ZIP)  - Updated 11/25/2022

ICD-10 MS-DRGs V39.1 Effective April 1, 2022  (ZIP)  - Updated 11/16/2021

ICD-10 MS-DRGs V38.1 Effective January 1, 2021 (ZIP)

ICD-10 MS-DRGs Version 37.2 Effective August 01, 2020 (PDF)

July 2020 Quarterly Update to the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2020 Pricer (PDF)

ICD-10 MS-DRGs Version 37.1 R1 Effective April 1, 2020 - Updated March 23, 2020 (PDF)

ICD-10 MS-DRGs Version 37.1 Effective April 1, 2020 (PDF)  

MS-DRG CC/MCC Comprehensive Analysis Information

CMS hosted a listening session that described the Medicare-Severity Diagnosis-Related Group (MS‑DRG) Complication and Comorbidity (CC)/Major Complication and Comorbidity (MCC) Comprehensive Analysis discussed in the FY 2020 Inpatient Prospective Payment System (IPPS) proposed and final rules. This listening session included a review of the methodology to measure the impact on resource use and provided an opportunity for CMS to receive public input on this analysis and to address any clarifying questions in order to assist the public in formulating written comments on the current severity level designations for consideration in future rulemaking.

This listening session was held on October 8, 2019; 2:00 – 3:00 PM ET.

For the transcript and audio file of the listening session, visit https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/Downloads/10082019ListingSessionTrasncriptandQandAsandAudioFile.zip .

Link to the supplementary file that was made available for the listening session:

• ICD-10-CM Diagnosis Codes Impact on Resource Use File - FY 2018 MedPAR (ZIP)    

We are providing updated impact on resource use files so that the public can review the mathematical data for the impact on resource use generated using claims from the FY 2019 - FY 2022 MedPAR files:

• ICD-10-CM Diagnosis Codes Impact on Resource Use File - FY2019 and FY2020 MedPAR (ZIP)
• ICD-10-CM Diagnosis Codes Impact on Resource Use File - FY2021 MedPAR (ZIP)
• ICD-10-CM Diagnosis Codes Impact on Resource Use File - FY2022 MedPAR (ZIP)

MS-DRG Definitions Manual and Software

Fy 2024 – version 41.1 (effective april 1, 2024 through september 30, 2024).

• Definition of Medicare Code Edits V41.1 (ZIP)  The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2024. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V41.1 (ZIP)  A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. - Updated 03/12/2024
• V41.1 Definitions Manual Table of Contents - Full Titles - HTML Versions - Updated 03/12/2024
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V41.1  MAINFRAME Software (ZIP) - Updated 03/12/2024
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V41.1, ICD-10 PC Software (ZIP) - Updated 03/12/2024
• Medicare Severity Diagnosis Related Group (MS-DRG) and Medicare Code Editor (MCE) Version 41.1 Java Source Code and Reference Implementation Binaries (ZIP) - Updated 03/14/2024
• Version 41.1 Appendix C Suppression Logic (PDF) - Updated 03/12/2024

FY 2024 – Version 41 (Effective October 1, 2023 through March 31, 2024 )

• Definition of Medicare Code Edits V41 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2024. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V41 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. - Updated 10/16/2023
• V41 Definitions Manual Table of Contents - Full Titles - HTML Versions   - Updated 10/23/2023
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V41  MAINFRAME Software (ZIP)  
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V41, ICD-10 PC Software (ZIP)  
• Medicare Severity Diagnosis Related Group (MS-DRG) and Medicare Code Editor (MCE) Version 41 Java Source Code and Reference Implementation Binaries (ZIP) - Updated 8/22/2023

Java Source Code vs. Executable Jars

• The Java Source Code (JAR files) are provided for transparency around the grouping and editing methodology internals. These files are not intended for direct use in applications but offer an opportunity for users to have some additional insight into the component’s inner workings.
• In addition to the source files, precompiled jar files and instructions are provided which can be used on any platform running Java.

FY 2024 – Version 41.A Alternate Test GROUPER – DRAFT file for FY 2024 IPPS/LTCH PPS Proposed Rule

This is a supporting file for the FY 2024 IPPS/LTCH PPS Proposed Rule .

We are providing an alternate test version of the ICD-10 MS-DRG GROUPER Software, Version 41.A, so that the public can better analyze and understand the impact of the proposals with application of the NonCC Subgroup Criteria included in the FY 2024 IPPS/LTCH PPS proposed rule. This alternate test software reflects the proposed GROUPER logic for FY 2024 with application of the NonCC Subgroup Criteria.  For additional information regarding the Version 41.A Alternate Test GROUPER please see the file titled CMS-1785-P Table 6P.1a below.

• Medicare Severity Diagnosis Related Group (MS-DRG) Alternate Test Grouper Software and Medicare Code Editor (MCE) Version 41.A, ICD-10 PC Software (ZIP)
• CMS-1785-P Table 6P.1a (ZIP) :  An Excel file that contains the mapped Version 41 FY 2024 ICD-10-CM codes and the deleted Version 40.1 FY 2023 ICD-10-CM codes that should be used for testing purposes with users’ available claims data.

We are providing a test version of the ICD-10 MS-DRG GROUPER Software, Version 41, so that the public can better analyze and understand the impact of the proposals included in the FY 2024 IPPS/LTCH PPS proposed rule. This test software reflects the proposed GROUPER logic for FY 2024.  For additional information regarding the Version 41 Test GROUPER please see the file titled CMS- 1785-P Table 6P.1a below.

In addition, users are able to view the draft version of the ICD-10 MS-DRG Definitions Manual, Version 41. 

• Proposed ICD-10 MS-DRG Definitions Manual Files V41 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the proposed ICD-10 MS-DRG Grouper logic. 
• Proposed ICD-10-CM/PCS MS-DRG V41 Definitions Manual Table of Contents - Full Titles - HTML Version
• Medicare Severity Diagnosis Related Group (MS-DRG) Test Grouper Software and Medicare Code Editor (MCE) Version 41, ICD-10 PC Software (ZIP)
• CMS-1785-P Table 6P.1a (ZIP) :  An Excel file that contains the mapped Version 41 FY 2024 ICD-10-CM codes and the deleted Version 40.1 FY 2023 ICD-10-CM codes that should be used for testing purposes with users’ available claims data
• Definition of Medicare Code Edits V40.1 (ZIP)  The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2023. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V40.1 (ZIP) A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.
• V40.1  Definitions Manual Table of Contents - Full Titles - HTML Versions
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V40.1  MAINFRAME Software (ZIP)
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V40.1, ICD-10 PC Software (ZIP)
• Medicare Severity Diagnosis Related Group (MS-DRG) and Medicare Code Editor (MCE) Version 40.1 Java Source Code and Reference Implementation Binaries (ZIP)

09/02/2022 Update: We are providing a re-release of the version 40 software to reflect updates that have been made to enhance the performance of the software. These updates do not affect any testing or grouping results.

For both the MS-DRG and MCE Java Mainframe software packages the following changes were made to the executable software.

• The class hierarchy of common class files was name spaced to remove any potential conflict when multiple grouping or editing Java applications are run by a single larger program on the Mainframe
• The Logging Error Message referring to “slf4j.impl.StaticLoggerBinder” has been corrected so this warning no longer appears. (This warning had no effect on the component functionality).
• Please refer to the Sample Environment file in the java folder to add “COBJVMINITOPTIONS=-Djzos.merge.sysout=true” to the Environment file on your USS system. For MS-DRG, refer to folder CMSDRG400_MF_Java_jar. For MCE, refer to folder MCEV400_MF_Java_jar folder.
• The COBOL wrapping programs provided have been enhanced to add “redirectStandardStreams” which allows greater flexibility in the location of log files on the Mainframe system

For the MS-DRG Mainframe reference files the following changes and clarifications are provided.

• For the DXPATERN file, The ‘XXX’ entries were removed from the file; these were placeholders for empty attributes (codes with no attributes for the OPERAND column) and were inadvertently left in.
• For the PRPATERN file, the ‘nonor’ attribute was not in the legacy flat files, but now appears. It is a better representation of the operating room severity levels - the ‘nonor’ attribute is meant to indicate the procedures that are non-operating room procedures. The PRATTLST file was annotated to include this attribute. 
• FORMULA_COLLECTION_ID column removed from the file, it is an internal field that is unnecessary for users.
• There is an attribute in the formulas, called ‘ORPROC’ that appears in many of the DRG formulas. This does not appear in the PRATTLST anywhere. This is meant to indicate codes that are operating room procedures, either extensive (attribute d68) or non-extensive (attribute d477). Replaced all mention of ‘ORPROC’ with ‘d468 OR d477’ in the DRGLOGIC file (both attributes already appear in the PRATTLST file). 
• Definition of Medicare Code Edits V40 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2023. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V40 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. 
• V40 Definitions Manual Table of Contents - Full Titles - HTML Versions  
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V40  MAINFRAME Software (ZIP)  - Updated 11/03/2022: This is a replacement of the previously released Medicare Severity Diagnosis Related Groups v40.0 I-10 z/OS (Java) Batch Mainframe Software.  The updated zip file addresses the POA logic flag that was not recognizing the POA Exempt status X in the Mainframe wrapper. 
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V40, ICD-10 PC Software (ZIP)
• Medicare Severity Diagnosis Related Group (MS-DRG) and Medicare Code Editor (MCE) Version 40 Java Source Code and Reference Implementation Binaries (ZIP)

This is a supporting file for the FY 2023 IPPS/LTCH PPS Proposed Rule

We are providing a test version of the ICD-10 MS-DRG GROUPER Software, Version 40, so that the public can better analyze and understand the impact of the proposals included in the FY 2023 IPPS/LTCH PPS proposed rule. This test software reflects the proposed GROUPER logic for FY 2023.  For additional information regarding the Version 40 Test GROUPER please see the file titled CMS-1771-P Table 6P.1a below.

In addition, users are able to view the draft version of the ICD-10 MS-DRG Definitions Manual, Version 40.

• Proposed ICD-10 MS-DRG Definitions Manual Files V40 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the proposed ICD-10 MS-DRG Grouper logic.
• Proposed ICD-10-CM/PCS MS-DRG V40 Definitions Manual Table of Contents - Full Titles - HTML Version
• Medicare Severity Diagnosis Related Group (MS-DRG) Test Grouper Software and Medicare Code Editor (MCE) Version 40, ICD-10 PC Software (ZIP)
• CMS-1771-P Table 6P.1a (ZIP) : An Excel file that contains the mapped Version 40 FY 2023 ICD-10-CM codes and the deleted Version 39.1 FY 2022 ICD-10-CM codes that should be used for testing purposes with users’ available claims data.

Update 07/18/2022 : We are providing a re-release of the version 39.1 software to reflect the standalone Java MCE binaries, sources, and documentation zip file in the PC software.  These updates do not affect any testing or grouping results

• Definition of Medicare Code Edits V39.1 (ZIP)   - Updated 3/14/22: The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2022. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V39.1 (ZIP)   - Updated 3/18/22: A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.
• V39.1  Definitions Manual Table of Contents - Full Titles - HTML Versions  - Updated 3/18/22
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V39.1  MAINFRAME Software (ZIP)  -   Updated 3/14/22
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V39.1, ICD-10 PC Software (ZIP)  -   Updated 7/18/22

Update 12/22/2021 : The Apache Log4j open-source logging software library is used in the PC and Java based grouping and editing software (MS-DRG Java, MCE Java, MSGMCE). Recently, a vulnerability was discovered in Log4j that could present security issues when running under certain conditions. The Mainframe BAL software is not impacted.

Apache has issued an updated version of Log4j (2.16.0) to fix this issue. The updated software removes any potential association with the vulnerability.

There is no impact or change to any grouping or editing results or data files.

We have provided updated software files in order to remove any potential association with the vulnerability.

MS-DRG and MCE Mainframe Java distribution updates:

• Removed Log4j from the MS-DRG Mainframe and MCE Mainframe Java software packages as this logging is not utilized in this environment
• Updated the documentation for the standalone Java MS-DRG and MCE to reference 2.16.0 of Log4j

MSGMCE Products

•  Updated the Log4j version used to 2.16.0 from the current versions (MSGMCE PC - 2.7)
•   Definition of Medicare Code Edits V39 (ZIP)   :The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2022. Zip file contains a PDF and text file that is 508 compliant.   
• ICD-10 MS-DRG Definitions Manual Files V39 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.   
• V39  Definitions Manual Table of Contents - Full Titles - HTML Versions  
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 39  MAINFRAME Software (ZIP)   - Updated 12/22/21  
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 39, ICD-10 PC Software (ZIP)  - Updated 12/22/21

This is a supporting file for the FY 2022 IPPS/LTCH PPS Proposed Rule

We are providing a test version of the ICD-10 MS-DRG GROUPER Software, Version 39, so that the public can better analyze and understand the impact of the proposals included in the FY 2022 IPPS/LTCH PPS proposed rule. This test software reflects the proposed GROUPER logic for FY 2022. For additional information regarding the Version 39 Test GROUPER please see the file titled CMS-1752-P Tables 6P.1a and 6P.1b below.

In addition, users are able to view the draft version of the ICD-10 MS-DRG Definitions Manual, Version 39.

• Proposed ICD-10 MS-DRG Definitions Manual Files V39 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the proposed ICD-10 MS-DRG Grouper logic.
• Proposed ICD-10-CM/PCS MS-DRG V39 Definitions Manual Table of Contents - Full Titles - HTML Version
• Medicare Severity Diagnosis Related Group (MS-DRG) Test Grouper Software and Medicare Code Editor (MCE) Version 39, ICD-10 PC Software (ZIP)
• CMS-1752-P Table 6P.1a and 6P.1b (ZIP) : An Excel file that contains the mapped Version 39 FY 2022 ICD-10-CM and ICD-10-PCS codes and the deleted Version 38 FY 2021 ICD-10-CM and ICD-10-PCS codes that should be used for testing purposes with users’ available claims data.
• Definition of Medicare Code Edits V38.1 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2021. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V38.1 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. 
• V38.1  Definitions Manual Table of Contents - Full Titles - HTML Versions
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V38.1  MAINFRAME Software (ZIP)
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V38.1, ICD-10 PC Software (ZIP)

The MS-DRG Java zip file has been updated to include a missing dependency required for testing. The MS-DRG Java API and calling example documentation has been updated to include references to this dependency as well as corrections to make method naming consist. The MS-DRG and MCE Java Mainframe deliverables have updated install guide PDF with corrections for clarity. There were no changes made to the functionality or content of MS-DRG or MCE.

Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Java Beta Version 38.1 MAINFRAME Software (ZIP)   - UPDATED 5.24.21

Inquiries related to this Java Beta version of the Grouper should be directed to  [email protected]

Errata (PDF) : A document describing the changes from Version 38 to Version 38.0 R1

• Definition of Medicare Code Edits V38.0 R1 (ZIP) :  The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2021. Zip file contains a PDF and text file that is 508 compliant
• ICD-10 MS-DRG Definitions Manual Files V38.0 R1 (ZIP) :  A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. 
• V38.0 R1 Definitions Manual Table of Contents - Full Titles - HTML Versions 
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V38.0 R1 MAINFRAME Software (ZIP)
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V38.0 R1, ICD-10 PC Software (ZIP)

This is a supporting file for the FY 2021 IPPS/LTCH PPS Proposed Rule  

We are providing a test version of the ICD-10 MS-DRG GROUPER Software, Version 38, so that the public can better analyze and understand the impact of the proposals included in the FY 2021 IPPS/LTCH PPS proposed rule. This test software reflects the proposed GROUPER logic for FY 2021.  For additional information regarding the Version 38 Test GROUPER please see the file titled CMS-1735-P Table 6P.1a below.

In addition, users are able to view the draft version of the ICD-10 MS-DRG Definitions Manual, Version 38. 

• Proposed ICD-10 MS-DRG Definitions Manual Files V38 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the proposed ICD-10 MS-DRG Grouper logic. 
• Proposed ICD-10-CM/PCS MS-DRG V38 Definitions Manual Table of Contents - Full Titles - HTML Version
• Medicare Severity Diagnosis Related Group (MS-DRG) Test Grouper Software and Medicare Code Editor (MCE) Version 38, ICD-10 PC Software (ZIP)
• CMS-1735-P Table 6P.1a (ZIP) : An Excel file that contains the mapped Version 38 FY 2021 ICD-10-CM codes and the deleted Version 37 FY 2020 ICD-10-CM codes that should be used for testing purposes with users’ available claims data.
• Definition of Medicare Code Edits V37.2 (ZIP) :The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2020. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files V37.2 (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. 
• V37.2 Definitions Manual Table of Contents - Full Titles - HTML Versions
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37.2   MAINFRAME Software (ZIP)      
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37.2, ICD-10 PC Software (ZIP)  
• Definition of Medicare Code Edits V37.1 R1 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2020. Zip file contains a PDF and text file that is 508 compliant
• ICD-10 MS-DRG Definitions Manual Files V37.1 R1 (ZIP)   : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.  
• ICD-10-CM/PCS MS-DRG V37.1 R1 Definitions Manual Table of Contents - Full Titles - HTML Versions - UPDATED
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37.1 R1   MAINFRAME Software (ZIP)  
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37.1 R1, ICD-10 PC Software (ZIP)   (ZIP)
• Definition of Medicare Code Edits v37 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2020. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files v37 R1 (Updated September 19, 2019) (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.
• ICD-10-CM/PCS MS-DRG v37 R1 Definitions Manual Table of Contents - Full Titles - HTML Versions-UPDATED - Opens in a new window    
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper MAINFRAME Software and ERRATA, v37 R1 (Updated September 18, 2019) (ZIP)    
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 37, ICD-10 PC Software - Opens in a new window
• Definition of Medicare Code Edits v36 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2019. Zip file contains a PDF and text file that is 508 compliant.
• Errata and ICD-10 MS-DRG Definitions Manual Files v36 R1 (Updated October 09, 2018) (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic. 
• ICD-10-CM/PCS MS-DRG v36 R1 Definitions Manual Table of Contents - Full Titles - HTML Versions (Updated October 12, 2018)
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 36, ICD-10 Software - Opens in a new window    
• Definition of Medicare Code Edits v35 (ZIP) : The ICD-10 Definitions of Medicare Code Edits file contains the following: A description of each coding edit with the corresponding code lists as well as all the edits and the code lists effective for FY 2018. Zip file contains a PDF and text file that is 508 compliant.
• ICD-10 MS-DRG Definitions Manual Files v35 (Updated September 12, 2017) (ZIP) : A zip file with the ICD-10 MS DRG Definitions Manual (Text Version) contains the complete documentation of the ICD-10 MS-DRG Grouper logic.
• ICD-10-CM/PCS MS-DRG v35 Definitions Manual Table of Contents - Full Titles - HTML Versions (Updated September 13, 2017)
• Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version 35 R1, ICD-10 Software (ZIP, 125MB) - Opens in a new window    

HCPCS-MS-DRG Definitions Manual and Software

The 21 st Century Cures Act requires that by January 1, 2018, the Secretary develop an informational “HCPCS version” of at least 10 surgical MS-DRGs.  Under the HCPCS version of the MS-DRGs developed for this requirement, to the extent feasible, the MS-DRG assignment for a given service furnished to an outpatient (billed using a HCPCS code) is as similar as possible to the MS-DRG assignment for that service if furnished to an inpatient (billed using an ICD-10-PCS code).

The HCPCS-MS-DRG definitions manual and software developed under the requirements of section 15001 of the 21st Century Cures Act (Public Law 114–255). Questions about the posted HCPCS-MS-DRG definitions manual and software can be directed to [email protected] .

• HCPCS-DRG V1.0 Software, User Manual, Definitions Manual, and Test Case Files - Opens in a new window    

Pickaxe Customization

• View history

The Pickaxe Customization terminal

The Pickaxe Customization terminal allows the modification of the Pickaxe model regarding 7 different parts: Frontblade, Head, Backblade, Shaft, Handle, Pommel and Paintjob.

Parts are obtained from Lost Pack , Prestige Assignments or Cosmetics DLC .

You can randomize the pickaxe with the button below the pickaxe.

• 1 Pickaxe Sets
• 2 Unique Parts
• 3 Season 02 Performance Pass
• 4 Season 03 Performance Pass
• 5 DLC Paintjobs

Pickaxe Sets [ ]

A custom Pickaxe example

Unique Parts [ ]

The Frontblade and Backblade parts for a specific set are awarded together. Prestige Pickaxe set Backblades comes with a unique model and a copy of the Frontblade.

Unique Backblade from Lost Pack : Chop-Chop, Hole Digger, Obsidian Mallet, Skull Buster.

Season 02 Performance Pass [ ]

The parts for the Core Hound are rewarded at various levels of the Performance Pass .

Front Blade: Level 19 Back Blade: Level 24 Handle: Level 35 Head: Level 53 Shaft: Level 76 Paintjob: Level 81 Pommel: Level 91

Season 03 Performance Pass [ ]

The parts for the Blight Guard are rewarded at various levels of the Performance Pass .

Back Blade: Level 8 Handle: Level 15 Head: Level 38 Front Blade: Level 45 Shaft: Level 55 Pommel: Level 79 Paintjob: Level 85

DLC Paintjobs [ ]

Paintjob [ ]

In the Space Rig by the Pickaxe Station one can see unreleased and potentially upcoming pickaxe parts.

• ↑ 1.0 1.1 1.2 From Season 01: Rival Incursion Performance Pass .
• 1 Promotion
• 2 Equipment
• 3 Machine Events

San Francisco Giants | SF Giants DFA Joey Bart, ending tenure of…

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San Francisco Giants

San francisco giants | sf giants dfa joey bart, ending tenure of former no. 2 overall draft pick, bart can be traded for the next week but will be placed on waivers if the giants don’t find a partner; rhp daulton jefferies took his roster spot.

SAN DIEGO — Once anointed the eventual successor to Buster Posey, Joey Bart’s time with the San Francisco Giants came to an end Sunday.

Bart, the second overall selection in the 2018 draft, was designated for assignment to open a roster spot for right-hander Daulton Jefferies, who was called up to start the Giants’ series finale against the Padres. While the Giants initially opted to carry Bart on their Opening Day roster, the move was a long time coming after they signed Tom Murphy to be Patrick Bailey’s primary backup.

Bart, 27, is eligible to be traded for the next week, but if the Giants cannot find a partner, he would be placed on unconditional release waivers, where he is almost certain to be claimed and added to another team’s major-league roster. He has no options remaining and can’t be sent to the minors without being placed on waivers again.

In a text message, Bart said he “just wish(es) the best for my teammates and excited for a new opportunity.”

A change of scenery could benefit Bart, who never quite escaped from Posey’s shadow. It was always going be difficult to fill the shoes of the Giants’ franchise catcher, and Bart’s duty was only made more difficult by conditions outside his control.

When he was tearing up the Arizona Fall League in 2019, Bart was hit in the hand by a pitch, ending his season. The next year, Bart was thrust into the starting job in the majors when Posey opted out of the pandemic season, despite not playing a game above Double-A. And when Posey returned for 2021, Bart was left to toil at Triple-A almost all season, rather than learn under his predecessor as his backup during their 107-win season.

“Sometimes when you have to move on from your first team, it’s hard,” manager Bob Melvin said. “But I think he’s going to get a better opportunity than he was afforded here.”

A former catcher, Melvin would know, having been traded from the Tigers after his rookie season to San Francisco, where he established himself as a big leaguer and went on to enjoy a 10-year playing career. Throughout spring, Melvin touted Bart’s attitude as well as the strides he made as a player.

“It certainly looked to me like he developed this spring,” Melvin said. “I know it was a quick ascent for him and it was difficult, you’re coming in after a legend here and things don’t go smoothly right away. Now all of a sudden you’re up and down. That can be hard, and hard on your psyche as well. But I think he got past that this spring and came into spring training in a good place and was just looking forward to having a good spring, knowing something like this might happen.”

Bart was the final first-round pick of the previous regime under Bobby Evans. Once Farhan Zaidi arrived in 2019, the Giants used their top selection on another catcher, Patrick Bailey, just a year after spending the second overall pick on Bart.

Bailey arrived midway through last season and seized the starting job, effectively putting a ticking clock on Bart’s tenure with the organization. There was some thought the Giants could pair their two first-round catchers, but that was snuffed out when they agreed to a two-year deal with Murphy.

“I feel like our relationship probably grew the most in these last couple weeks,” Bailey said. “He was awesome the whole time. He’s a great dude. I love being around him. I hate to see him go. It’s kind of the tough part of the business, but I know wherever he ends up, he’s going to do just fine.”

Jefferies completes long road back

Jefferies, 28, made his first major-league start since May 18, 2022, before he underwent thoracic outlet surgery and his second Tommy John procedure.

Posting a 2.25 ERA and a 15:3 strikeout-to-walk ratio in four spring training outings, Jefferies didn’t open the season on the active roster but was always slated to start the fourth game of the season, which Melvin informed him of before hitting the road, adding an extra layer of flair for the fellow Cal product.

“I even played the Cal fight song when I told him he was going to be on the team,” Melvin said. “You don’t realize how lonely rehab is, and then a second one is really tough on you. The uncertainty if you’re going to get back, then to actually sign with a team … it’s pretty cool. I think he felt really good about working as hard as he did and getting the fruits of his hard labor to get to this point again. So, an exciting day for us and an exciting day for him.”

Snell still TBD

After facing a lineup of minor-leaguers for four innings Friday night, Blake Snell still doesn’t have a determined date to join the Giants rotation. He struck out 11 while throwing 71 pitches and allowing three hits.

“Just trying to get ready,” he said. “The big leagues is definitely a lot different, so I don’t take that too seriously. I feel good. Just getting more reps, better and better, stronger and stronger. When I get out there, that’ll be when I’m able to tell where I’m at.”

When that might be, Snell wasn’t prepared to say.

If he remains on regular rest, his next turn through the rotation would line up with the Giants’ series finale at Dodger Stadium.

“I have ideas,” Snell said, “but nothing solid yet. The next couple days we should know.”

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Deep Rock Galactic

• Launched from the mission select terminal, complete at least your primary objective and get to the drop pod in time.

• See "Miner"

• Milestones can be found in your own sleeping quarters, and completing milestones earns you perk points to use on perks.

• See "Performance Matters"

• Perk nodes can be unlocked by spending perk points gained from completing milestones. This is done from the milestone terminal in your sleeping quarters.

• This includes all 10 customization slots-; Headwear, Armor, Paintjob, Skin Color, Victory Move, Eyebrows, Sideburns, Moustache, Beard and Hair color. These are changed from the Wardrobe after purchasing them from the "Shop"
• This means that don't equip the items in the shop when you've purchased them, instead go and equip them from the wardrobe afterwards.

• Moustaches can be purchased from the "Shop".

• Assignments can be accepted from the Assignment Terminal, and to complete them, you have to complete a specific mission for each part of the assignment. The current assignment mission is always marked with a diagonal square.

• This should be relatively easy. The difficulty can be changed right before confirming the mission.

• Don't rush it.

• Contrary to the previous one, do rush this one.

• Easier in co-op, preferably 2 or maybe 3 players.

• See "Consistent Performance". Suspending yourself with the Gunner's zip line or using the Scout's grappling hook to get away can help.

• See "Bring Your A-Game". Do not stay for secondary objectives.

• Preferrably play with 2 players and use characters that have already been promoted.

• See "Employee Of The Month" and "Going Lethal".
• This time Gunners and Drillers are useful, as their large damage output can quickly kill everything even remotely close to you. Remember to use your shield generator as much as possible

• 2 players, promoted dwarves, and by personal experience, both Gunners as their shields will help tremendously when returning to the drop pod and waiting for the mule.
• Pick the shortest mining expedition with the lowest cave complexity and mission length (200 morkite is the lowest requirement), and preferably do this when there is Dark Morkite available in the Abyss Bar, as that will definitely help you reach the objective in time.
• You will probably have to restart a couple of times as a lot of it is up to RNG. You need to mine all required morkite and hit the mule's drop pod return button before the mission timer hits 5 to 6 minutes, because that's when the first swarm spawns. You have to ignore everything else but Morkite, this time even Nitra as you're not gonna want a resupply.
• When returning to the drop pod and there's a huge swarm behind you, sometimes you can drop a shield in a narrow part of the cave like a dirt hole and keep running forward because the shield will block every bug that's behind you. As you reach the drop pod and if you're both gunners, you can both keep dropping shields when the previous one runs out and both shoot down any enemies outside the shields.

• You can promote your dwarf after reaching character level 25 and completing it's specific promotion assignment missions from the character selection terminal.
• You don't actually have to complete the assignment mission as the dwarf you're promoting, instead you can start leveling up the next dwarf.
• For optimal XP grinding, of course Double XP will always help, but also you should complete every rival sabotage opportunity and matrix core infuser task. Higher hazard levels, warnings and longer missions will also give higher XP amounts, so experiment with this and do whatever it is that you're comfortable with.

• See "Movin' On Up".

• See "Movin' On Up". Promote any dwarf four times.

• See "Movin' On Up". Promote all dwarves at least four times.

• See "Movin' On Up". Promote any dwarf seven times.

• See "Movin' On Up". Promote all dwarves at least seven times.

• Deep Dives can be found in the Deep Dive terminal. Deep Dives are basically three missions in one, and the secondary objects are simplified or shortened primary objectives.
• The difficulties of normal Deep Dives are Hazard Levels 3, 3.5 and 3.5 respective to each consecutive mission.
• Ammo and materials (most importantly Nitra) will carry over the three missions, meaning you shouldn't waste all you ammo shooting your teammates in the drop pod waiting for that one engineer 136 meters away.

• See "Going Deeper". You can complete one normal Deep Dive and one Elite Deep Dive every week.

• The difficulties of Elite Deep Dives are Hazard levels 4.5, 5 and 5.5 respective to each consecutive mission.
• Personally, I did this solo, but I'd say it's easiest to do it with 2 players if you're not familiar with Bosco (See "Lone Wolf" for tips with Bosco). A Driller and a Gunner would probably be easiest for their high damage output for both single target and crowd control.
• Mine all the Nitra you can find, and always stay stocked up with ammo. If you run out of ammo while being attacked by a swarm of bugs, things can quickly go south for your entire team.
• Take your time and don't rush it, though I'd still suggest you should ignore gold.
• Certain things, like active perks and Bosco's revives will reset between missions, so don't hesitate to use them as much as possible.
• If you still find the deep dive too hard, you can always wait for next week's dive. They are seeded, meaning it's always the same during one week, but changes the next week.

• Focusing only on the objectives and mining just the easily accessible nitra will help, and also solo missions will usually last less due to less enemies and no sharing resupplies.
• Normal deep dives can usually be completed around 45 minutes even without the tips above, but if you find the dive at the time too difficult to complete in time, you can always wait for next weeks dive.

• Warnings are mission mutators that change the difficulty to harder. Warnings can be seen as red indicators when selecting a mission. Warnings also give varying hazard bonuses.
• Currently, there are tweleve different warnings: Cave Leech Clusters, Exploder Infestation, Haunted Cave, Lethal Enemies, Lithophage Outbreak, Low Oxygen, Mactera Plague, Parasites, Regenerative Bugs, Rival Presence, Elite Threat and Shield disruption.

• BET-C can be found in caves accompanied with a distinguishable pulsating sound heard from far away. Once approached, the BET-C will start attacking the players. You must shoot the Xynarch Charge-Suckers from the sides of the BET-C to disable it. After disabling, the BET-C can be re-enabled to fight for the dwarves.

• You won't miss them. Shooting them in the glowing balls on their back will do critical damage.

• Mini M.U.L.E.s are found in Salvage Operation missions. Each dwarf actively repairing one once it's finished will get progress towards the achievement.

• Dreadnoughts are found in Elimination Missions. Currently, there are three different dreadnought types; the "normal" Glyphid Dreadnaught, the dreadnaught twins, Dreadnaught Arbalest and Dreadnaught Lacerator and then the Dreadnaught Hiveguard
• In a rare event, a dreadnought can intercept your team replacing a normal swarm.

• Knowing the location of both eggs and having an easy route between them will be helpful.

• Break both eggs and fight them simultaneously, damage them enough to be on low HP, and then try to kill them at the same time. 2+ players required, 4 would be the easiest as in teams of 2, where the other player will draw the fire and the other player damages it from behind.
• Remember, all dwarves will need to do damage to both Dreadnoughts before killing them.
• The Dreadnought Arbalest and Lacerator count as one Dreadnought, meaning you can kill one of them early and save the other for the achievement.

• Gold chunks can be found in the ground where there are small gold chunks sticking out of the ground accompanied with a yellow glow.

• Bittergems can be found in the ground where there are small purple chunks sticking out of the ground accompanied with a purple glow.

• Easily achievable when Molly is called back to the Drop Pod after completing a mission.

• Silicate Harvesters can be found on Dense Biozone, Fungus Bogs and Radioactive Exclusion Zone. They are passive creatures, therefore they will not attack you.

• See "Farmer". Every dwarf must kill five enemies to get the achievement, but for one dwarf to get this achievement, the others don't have to kill any bugs.
• Avoid using explosives, as they can accidentally kill the harvester.
• Glyphid Swarmers are the easiest to do this with, as you only need to rile up a nest for them to spawn.

• Every time when the Drilldozer starts moving, a swarm appears. This is the optimal time to do this.
• Same as "Car Pool", each dwarf has to kill 15 enemies individually to get the achievement, but for one to get it, the other ones don't need to kill them.
• Any other dwarf than the Scout should have the sufficient firepower to easily do this, though it is possible with all dwarves.

• Pipes are deployed from the three sides of the Pumpjack, and as far as I know, there is no limit to how long they can be, but once connected to a Morkite well, they cannot be extended.
• Your speed accelerates when sliding down a pipe, so preferably start building them in a spiraling pattern upwards. Easiest way should be to do them in a large, open area, such as Sandblasted Corridors, and with the Engineer's platforms going around the walls.

• Wedging a barrel to a corner will help.
• Also if you're the host or in a private lobby, the barrels won't bug out nearly as much as being in another players lobby.

• Do your friend a favor and buy this game for them, they'll appreciate it. Public lobbies also work I guess.

• Kick the barrel when the hoop goes right to left, as when it's changing direction on the right side it won't change speed. You'll learn the timing after a few tries. Also there is a significant bonus to hitting consecutive shots, and it is lost when you miss or there is too much time between the shots.
• If you're in a lobby with other dwarves, only one of them needs to do this in under 100 barrels, and the only thing the others have to do is kick one barrel in the hoop to get this achievement.

• The mission has to be selected as Solo, hosting a private mission and playing it alone won't work.
• Mine minerals, gems and eggs hidden in the walls
• Light up areas
• Target a specific enemy
• Build Pipelines
• Carry heavier items
• Shoot rockets (right click, and only if the rocket upgrade is unlocked)
• Bosco can also revive you 2 to 4 times per mission, depending on your upgrades.
• Solo Deep Dives don't count towards this achievement.

• See "Lone Wolf"

• New weapons are unlocked by completing their respective assignments from the assignment terminal after your dwarf has reached level 10 for the primary weapon or level 15 for the secondary weapon.

• Every upgradable item means primary, secondary, pickaxe, support, utility and armor rig.

• You can upgrade Bosco from the Drone Modification terminal.

• Staying in the Space Rig and then starting a mission should work, though I'm not so sure about that. If you do it in a mission, the achievement should pop as soon as you reach one hour.

• Weak spots are usually in the mouth, abdomen or other glowing parts.

• Be careful not to go down during the fight, or it will not grant you the achievement.

• Empty all ammo from your primary and secondary and then break the egg with your pickaxe and the achievement should pop.
• If this doesn't work, you can try emptying your support and utility weapon ammo and your grenades. As a last resort, you can also try disabling Bosco from it's customization terminal before the mission.

• Self explanatory, and only the host will get it.

• These cubes are called ERR://23¤Y%/ and can be found in caves with grey pulsating spikes coming from the ground accompanied with a purple glow. As of now, they are extremely rare and don't do anything.

• You can buy Oily Oaf Brew, Glyphid Slammer and Leaf Lover's Special with only credits and without having to unlock any beer licenses.

• Jump through the barrel hoop while drunk.

• Throw an empty beer keg through the barrel hoop. This can be done slightly easier from under the barrel hoop.

• See "If Only I Got Paid For This...".

• Just don't... It's not that hard.

• Launch Bay, as in under the Drop Pod on the force field.

• Kick them up via the ladder to the Drop Pod, and then make sure the barrels are deep enough in the seats so that they don't really have space to move around.

• If the barrels fall down to the Launch Bay, you can get them up via the ladder or the small hole in the wall. The barrels can also sometimes bug out and disappear forcing you to start all over again.

• With a full team, all four players must salute with a beer keg in their hands at the same time while music is being played from the jukebox. The timing is relatively precise, so if you don't get it the first time, just try again.

• Dance to the Jukebox music for one hour. You can check your progress by going to your profile, click on games, scroll to DRG, then click on My Game Stats > My Leaderboards > Dancing Time > Show. A score of 3600 points is required to unlock the achievement.

• The Jukebox is located opposite to the Abyss Bar. You usually get this while doing "Happy Feet".