MS-DRGs

Medicare Severity Diagnosis Related Groups (MS-DRGs) are defined by CMS (Centers for Medicare and Medicaid Services). Clinical Analytics currently uses Version 41.0 of CMS MS-DRGs. For a full list of MS-DRGs, see ICD-10-CM/PCS MS-DRG v41.0 Definitions Manual.

The MS-DRG assignment for each inpatient encounter is calculated by an MS-DRG grouper software hosted by Clinical Analytics Software. Based on the diagnosis and procedure codes for an inpatient encounter, the grouper assigns an MS-DRG. Each MS-DRG is a subcategory of an MS-DRG Cluster where the MS-DRGs within the cluster identify the CC (Comorbidities or Complications) or MCC (Major Comorbidities or Complications) for the encounter. Each MS-DRG Cluster may have up to three MS-DRGs (CC/MCC/none), but some have only two.

For a complete list of clusters with the associated MS-DRG ranges, see MS-DRG clusters.

Benchmarks

When you select your Performance Profile grouping type to be MS-DRG, benchmarks are risk-adjusted to the MS-DRG level, so you are comparing your patient population to other patients with similar conditions. Use the risk-adjustment to anticipate similar resource usage between different patients ensure that your benchmarks are valid comparisons of performance. See Benchmark calculations for more information about how benchmark values are determined.

Client MS-DRG

Some clients create an MS-DRG for each encounter with data that they calculate with their own grouper. In Clinical Analytics, these clients have the option of grouping by the Client MS-DRG. In most cases, the Client MS-DRG matches the Axiom MS-DRG.

Why would they not match?

In Clinical Analytics, encounter data is grouped using the same MS-DRG grouper version as the benchmark data for better consistency. Because of this, Clinical Analytics may use an older version of the grouper than the client. As soon as the benchmark groupings are updated to the latest version, Clinical Analytics encounter groupings are also updated.