Inpatient billing

MS-DRG codes

86 top Medicare Severity Diagnosis-Related Groups with relative weights, LOS, and denial patterns.

DRGs indexed

MS-DRGs determine how Medicare and most commercial insurers pay for inpatient hospital admissions under the prospective payment system (IPPS). Each DRG bundles all hospital costs for an admission into a single payment based on the patient's principal diagnosis, secondary diagnoses (CCs and MCCs), procedures, age, sex, and discharge disposition. CMS updates the MS-DRG grouper logic annually; FY2024 has 767 distinct DRGs across 25 Major Diagnostic Categories (MDCs).

DRG-level denials are common: insurers may downgrade a DRG by challenging an MCC or CC, deny inpatient status entirely (recommending observation), or audit length-of-stay outliers. Click any DRG below for its clinical context, typical denial patterns, and appeal angles.

MDC 01: Nervous System

DRG	Title	Relative weight	Avg LOS
023	Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis with MCC or Chemo Implant or Epilepsy with Neurostimulator	6.2342	11.8 days
025	Craniotomy and Endovascular Intracranial Procedures with MCC	4.6889	9.4 days
027	Craniotomy and Endovascular Intracranial Procedures without CC/MCC	2.5234	4.2 days
064	Intracranial Hemorrhage or Cerebral Infarction with MCC	1.9542	5.9 days
065	Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 Hours	1.3742	3.9 days
066	Intracranial Hemorrhage or Cerebral Infarction without CC/MCC	1.0234	2.8 days
069	Transient Ischemia	0.7421	2.0 days
070	Nonspecific Cerebrovascular Disorders with MCC	1.7234	5.1 days
074	Cranial and Peripheral Nerve Disorders with MCC	1.4582	4.7 days
100	Seizures with MCC	1.2842	3.8 days
101	Seizures without MCC	0.7321	2.4 days

MDC 04: Respiratory System

DRG	Title	Relative weight	Avg LOS
189	Pulmonary Edema and Respiratory Failure	1.2645	4.1 days
190	Chronic Obstructive Pulmonary Disease with MCC	1.1742	4.1 days
191	Chronic Obstructive Pulmonary Disease with CC	0.8542	3.4 days
192	Chronic Obstructive Pulmonary Disease without CC/MCC	0.7234	2.9 days
193	Simple Pneumonia and Pleurisy with MCC	1.4234	5.0 days
194	Simple Pneumonia and Pleurisy with CC	0.9542	3.8 days
195	Simple Pneumonia and Pleurisy without CC/MCC	0.7142	3.1 days
207	Respiratory System Diagnosis with Ventilator Support >96 Hours	6.3742	13.7 days
208	Respiratory System Diagnosis with Ventilator Support <=96 Hours	2.6234	5.5 days

MDC 05: Circulatory System

DRG	Title	Relative weight	Avg LOS
001	Heart Transplant or Implant of Heart Assist System with MCC	25.4516	32.6 days
216	Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC	12.8245	13.2 days
217	Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC	9.2734	9.8 days
218	Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC	8.0142	7.5 days
219	Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC	10.4456	11.3 days
236	Coronary Bypass without Cardiac Catheterization with MCC	8.5634	9.7 days
237	Major Cardiovascular Procedures with MCC	7.5234	9.3 days
238	Major Cardiovascular Procedures without MCC	4.1245	4.7 days
246	Percutaneous Cardiovascular Procedures with Drug-Eluting Stent with MCC or 4+ Vessels/Stents	3.6542	4.5 days
247	Percutaneous Cardiovascular Procedures with Drug-Eluting Stent without MCC	2.1543	2.4 days
280	Acute Myocardial Infarction, Discharged Alive with MCC	1.6534	5.4 days
281	Acute Myocardial Infarction, Discharged Alive with CC	1.0234	3.3 days
282	Acute Myocardial Infarction, Discharged Alive without CC/MCC	0.7842	2.4 days
287	Circulatory Disorders Except AMI, with Cardiac Catheterization with MCC	1.6234	4.6 days
291	Heart Failure and Shock with MCC	1.4632	4.5 days
292	Heart Failure and Shock with CC	0.9242	3.4 days
293	Heart Failure and Shock without CC/MCC	0.6845	2.6 days
299	Peripheral Vascular Disorders with MCC	1.4523	4.7 days
300	Peripheral Vascular Disorders with CC	0.9543	3.5 days
301	Peripheral Vascular Disorders without CC/MCC	0.7234	2.7 days
308	Cardiac Arrhythmia and Conduction Disorders with MCC	1.0342	3.5 days
309	Cardiac Arrhythmia and Conduction Disorders with CC	0.7642	2.7 days
310	Cardiac Arrhythmia and Conduction Disorders without CC/MCC	0.5842	2.1 days
312	Syncope and Collapse	0.7342	2.3 days
313	Chest Pain	0.6842	1.8 days

MDC 06: Digestive System

DRG	Title	Relative weight	Avg LOS
377	G.I. Hemorrhage with MCC	1.5942	4.6 days
378	G.I. Hemorrhage with CC	0.8542	3.0 days
379	G.I. Hemorrhage without CC/MCC	0.6234	2.2 days
391	Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with MCC	1.1742	3.8 days
392	Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders without MCC	0.7245	2.7 days

MDC 07: Hepatobiliary System and Pancreas

DRG	Title	Relative weight	Avg LOS
439	Disorders of Pancreas Except Malignancy with MCC	1.4534	4.7 days
440	Disorders of Pancreas Except Malignancy with CC	0.8842	3.4 days

MDC 08: Musculoskeletal

DRG	Title	Relative weight	Avg LOS
460	Spinal Fusion Except Cervical without MCC	5.3842	3.5 days
469	Major Joint Replacement or Reattachment of Lower Extremity with MCC	3.9234	5.7 days
470	Major Joint Replacement or Reattachment of Lower Extremity without MCC	1.8234	1.7 days
473	Cervical Spinal Fusion without CC/MCC	2.5234	1.5 days
552	Medical Back Problems without MCC	0.7345	2.8 days

MDC 09: Skin

DRG	Title	Relative weight	Avg LOS
603	Cellulitis without MCC	0.9223	3.3 days

MDC 10: Endocrine, Nutritional, Metabolic

DRG	Title	Relative weight	Avg LOS
640	Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC	1.4534	4.4 days
641	Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes without MCC	0.7942	3.0 days

MDC 11: Kidney/Urinary

DRG	Title	Relative weight	Avg LOS
682	Renal Failure with MCC	1.5142	4.8 days
683	Renal Failure with CC	0.9434	3.4 days
684	Renal Failure without CC/MCC	0.6842	2.6 days
689	Kidney and Urinary Tract Infections with MCC	1.1142	4.2 days
690	Kidney and Urinary Tract Infections without MCC	0.7445	3.0 days

MDC 14: Pregnancy/Childbirth

DRG	Title	Relative weight	Avg LOS
765	Cesarean Section with CC/MCC	1.1234	3.5 days
766	Cesarean Section without CC/MCC	0.7642	2.6 days
774	Vaginal Delivery with Complicating Diagnosis	0.7242	2.4 days
775	Vaginal Delivery without Complicating Diagnoses	0.5734	1.8 days

MDC 15: Newborns

DRG	Title	Relative weight	Avg LOS
794	Neonate with Other Significant Problems	1.0142	3.5 days
795	Normal Newborn	0.1942	2.4 days

MDC 18: Infectious

DRG	Title	Relative weight	Avg LOS
853	Infectious and Parasitic Diseases with O.R. Procedures with MCC	5.4234	11.4 days
870	Septicemia or Severe Sepsis with MV >96 Hours	6.0234	13.4 days
871	Septicemia or Severe Sepsis without MV >96 Hours with MCC	1.8745	5.5 days
872	Septicemia or Severe Sepsis without MV >96 Hours without MCC	1.0734	4.0 days

MDC 19: Mental Disorders

DRG	Title	Relative weight	Avg LOS
885	Psychoses	0.8534	5.7 days

MDC 20: Alcohol/Drug Use

DRG	Title	Relative weight	Avg LOS
894	Alcohol/Drug Abuse or Dependence, Left Against Medical Advice	0.4234	2.0 days
896	Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy with MCC	1.0234	4.4 days
897	Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy without MCC	0.5942	3.5 days

MDC 23: Factors Influencing Health Status

DRG	Title	Relative weight	Avg LOS
945	Rehabilitation with CC/MCC	1.3534	10.4 days
946	Rehabilitation without CC/MCC	0.9234	8.5 days
948	Signs and Symptoms without MCC	0.6942	2.6 days

MDC 24: Other

DRG	Title	Relative weight	Avg LOS
981	Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC	5.5234	9.4 days
982	Extensive O.R. Procedure Unrelated to Principal Diagnosis with CC	3.5234	5.7 days
983	Extensive O.R. Procedure Unrelated to Principal Diagnosis without CC/MCC	2.4534	3.4 days

MDC PRE: Pre-MDC

DRG	Title	Relative weight	Avg LOS
003	ECMO or Tracheostomy with Mechanical Ventilation >96 hours or PDX Except Face, Mouth and Neck with Major OR Procedure	17.8455	32.2 days

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