MS-DRG
MS-DRG 195: Simple Pneumonia and Pleurisy without CC/MCC
Uncomplicated pneumonia
DRG
195
MDC
MDC 04: Respiratory System
Severity
without CC/MCC
Relative weight
0.7142
Avg LOS
3.1 days
Typical indications
- Bacterial PNA
Common denial patterns
- Inpatient vs observation
Appeal angles
Document failed outpatient treatment + need for IV antibiotics.
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. 195 has relative weight 0.7142. 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 195?
Simple Pneumonia and Pleurisy without CC/MCC. Uncomplicated pneumonia.
What are typical indications?
Bacterial PNA.
Why are claims under this DRG denied?
Inpatient vs observation.
How do I appeal?
Document failed outpatient treatment + need for IV antibiotics.
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