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Basic of DRG code 177. 178 and 179

DRG codes are used by inpatient coders. While coding the inpatient charts ICD 10 CM codes are added in the coding software like 3M and DRG code are automatically reflected for the respective diagnosis. ICD-10 PCS codes are assigned depending on the procedures performed in the report.

Today, we will learn about the DRG code 177, 178 and 179 which comes under MDC 04 Diseases & Disorders of the respiratory system. Below you can see how the DRG codes are classified based on presence of MCC and CC diagnosis.

No CC & MCC | DRG code 179

The below patient length of stay in hospital was 50 days.

For coding DRG code 179, only the admit diagnosis and principle diagnosis will be coded. For example, as shown below when A0222 diagnosis is coded, DRG code 179 and MDC code 004 are added as per the details entered in the 3M software. Also you can see the estimated reimbursement code $3877.

Since the patient is not having any CC (complication or comorbidity) or MCC (major complication or comorbidity) the cost for reimbursement is less, as we add more complicated diagnosis the cost of reimbursement increases.

CC present | DRG code 178

Now , as you can see below as we add the CC diagnosis A020, the DRG code changes from 179 to 178. This will also increase the estimated reimbursement cost to $4935. This is the effect of CC on the DRG code and treatment cost.

Hence while coding inpatient chart it is important to capture the CC diagnosis from inpatient chart since they have great effect on treatment cost.

MCC present | DRG code 177

When MCC diagnosis is added in the above example, the DRG code changes to 177 and the estimated reimbursement cost increase to $7366. This shows that MCC diagnosis has more effect on reimbursement than CC diagnosis.

Also when both CC and MCC diagnosis are coded only the effect of MCC is considered for treatment cost.

CC & MCC present | DRG code 177

Even when both CC and MCC diagnosis codes are added, the final DRG code will be only 177. Even the estimated reimbursement will be same as above $7366. Here, only the effect of MCC diagnosis is considered when CC is present along with MCC diagnosis (as shown below).

Hope, this will give more knowledge about the importance of CC and MCC diagnosis and its effect on reimbursement on the DRG code 177, 178 and 179 for inpatient coders.