MS-DRG 897: Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy without MCC
Substance use no MCC, no rehab
Typical indications
- Withdrawal management
Common denial patterns
- MH parity
- Inpatient vs observation
Appeal angles
Document inpatient detox medical necessity per ASAM criteria.
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. 897 has relative weight 0.5942. 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 897?
Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy without MCC. Substance use no MCC, no rehab.
What are typical indications?
Withdrawal management.
Why are claims under this DRG denied?
MH parity; Inpatient vs observation.
How do I appeal?
Document inpatient detox medical necessity per ASAM criteria.
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