MS-DRG
MS-DRG 552: Medical Back Problems without MCC
Back pain admission
DRG
552
MDC
MDC 08: Musculoskeletal
Severity
without MCC
Relative weight
0.7345
Avg LOS
2.8 days
Typical indications
- Acute LBP + radiculopathy
Common denial patterns
- Inpatient necessity
Appeal angles
Document acute neuro deficit + inpatient pain mgmt.
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. 552 has relative weight 0.7345. 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 552?
Medical Back Problems without MCC. Back pain admission.
What are typical indications?
Acute LBP + radiculopathy.
Why are claims under this DRG denied?
Inpatient necessity.
How do I appeal?
Document acute neuro deficit + inpatient pain mgmt.
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