Data Needed To Assign a DRG

We are often asked what fields we need to assign a CMS (US Federal) DRG.

We need the following fields to assign a CMS DRG to an inpatient encounter:

1. The list of diagnoses, with the Primary diagnosis as the first code.
2. The list of procedures, if any.
3. The patient's age-on-admission
4. The patient's sex (Male, Female, Other, Unknown)
5. The patient's discharge status (use zero for "Unknown" and 20 for expired)
1. Home
2. Other Hospital
3. Skilled Nursing Facility (SNF)
4. Intensive Care Facility (ICF)
5. Other Institution (eg nursing home)
6. Home Care (VNA, etc)
7. Against Medical Advice (AMA)

And that is all that is needed.

Notes

• Using age-on-discharge usually returns a valid DRG.

• For our DRG Assignment Service...
• we usually want an encounter ID against which to return the DRG.
• We are happy to calculate the age-on-admission from a date of birth and an admission date.