What Are the DRGs in Coding?

The DRG abbreviation stands for Diagnosis Related Groups. DRG are used as a patient classification system to relate the reason a patient was seen in a hospital to the costs incurred by the hospital in the care of the patient. Patients are classified into Diagnostic, Demographic, and Therapeutic groups to analyze resource needs.

DRG Systems

• Many different DRG systems exist, such as: Medicare DRG (CMS-DRG & MS-DRG); Refined DRG (R-DRG); All Patient DRG (AP-DRG); Severity DRG (S-DRG); All Patient, Severity-Adjusted DRG (APS-DRG); All Patient Refined DRG (APR-DRG), and International-Refined DRG (IR-DRG).

Medicare DRG

• The Centers for Medicare and Medicaid Services publishes a list of DRG codes annually. Medicare uses the DRG reported to them to determine the fixed amount they will pay each hospital in advance for estimated or expected operating costs each year. Consider the following code examples: Diagnosis 799.51 (Attention or Concentration Deficit) falls into DRG category 886, while diagnoses 799.52 (Cognitive Communication Deficit); 799.55 (Frontal Lobe and Executive Function Deficit), and 799.59 (Other Signs and Symptoms Involving Cognition) belong in DRG category 884.

Other DRGs

• The DRG system has evolved to include more than the data needed by Medicare. In response to the health care industry's desire for more information, DRG schema have expanded to include the severity of the illness and the risk of mortality, as well as its original goal of tracking resource use. The APR-DRG accomplished this goal by adding four subclasses to each DRG. These subclasses are actually rankings, 1 through 4, signifying Minor, Moderate, Major, and Extreme severity of illness or risk of mortality, respectively.

International-Refined DRG (IR-DRG)

• The different DRG systems of various countries made it difficult to compare medical reporting from one country to another. The IR-DRG made it possible to provide comparable results regardless of the country the hospital was in. The ability to correlate international data has improved decision-making for direct patient care, statistical reporting, profiling, benchmarking, and clinical research.