Grouping to the new MS-DRGs

When CMS outlined MS-DRGs, a new set of Diagnosis-Related Groups, I can imagine some in the industry breathed a sigh of relief. Because rather than proposing a wholesale change from the 24-year-old DRG system, CMS used that familiar system as a starting point.

But while their choice of methodology will certainly make the change easier for some to handle, CMS has introduced a number of new changes in the DRG methodology. Understanding these changes is critical.

To help, my team at Ingenix has developed a web-based grouper that will take as inputs ICD-9 diagnosis and procedures codes, age, sex and discharge status and assign a CMS v24 DRG, an MS-DRG, the comparison of the relative weights between the DRGs and identify the CC and MCC diagnoses present on the data input.

To access this grouper, go to HospitalBenchmarks.com

The grouper is based upon information contained within the proposed rule. Ingenix has used this grouper on the MedPAR 2006 proposed rule data set and found agreement with CMS on greater than 99.9% of the claims. The majority of the disagreements between the Ingenix grouper and the CMS assigned MS-DRG deal with CCs/MCCs and the exclusions lists that have been published in the Federal register. All of these are part of the Ingenix formal response/questions to CMS about the new proposed rule severity adjusted DRGs.