MS-DRG
MS-DRG 194: Simple Pneumonia and Pleurisy with CC
CAP + CC
DRG
194
MDC
MDC 04: Respiratory System
Severity
with CC
Relative weight
0.9542
Avg LOS
3.8 days
Typical indications
- Pneumonia + diabetes uncomplicated
Common denial patterns
- CC validation
Appeal angles
Document CC and inpatient antimicrobial therapy need.
Context: how MS-DRGs work
MS-DRGs bundle hospital inpatient payment into a single amount per admission. Each DRG has a relative weight that multiplies the hospital's base rate to determine payment. 194 has relative weight 0.9542. Major Complication or Comorbidity (MCC) and Complication or Comorbidity (CC) secondary diagnoses can move a case to a higher-paying DRG within the same family.
Frequently asked questions
What is MS-DRG 194?
Simple Pneumonia and Pleurisy with CC. CAP + CC.
What are typical indications?
Pneumonia + diabetes uncomplicated.
Why are claims under this DRG denied?
CC validation.
How do I appeal?
Document CC and inpatient antimicrobial therapy need.
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