DRG_TABLE
This table provides helpful context and categories around Diagnosis Related Groups (DRGs) for inpatient medical billing.
What is a Diagnosis Related Group (DRG)?
A patient classification scheme that groups patients into categories based on their principal diagnosis, secondary diagnoses, surgical procedures, age, sex, and discharge status. DRGs are used to determine hospital reimbursement rates under Medicare's Prospective Payment System (PPS).
Bespoke nature of DRG creation can be messy
The creation of DRGs is a deeply human process. Individual judgement and relationship dynamics play an outsized role in the creation and determination of DRG codes and the corresponding financial values - and many of these nuances are not recorded in a reliable fashion.
- 🏥 DRGs are assigned to patients based on information reported by the hospital on the Medicare Inpatient Hospital Discharge Data (MS-DRG) abstract.
- 🕓 These abstracts contain information about the patient's primary diagnosis, up to 24 additional diagnoses, and up to 25 procedures performed during the stay.
- ☔ DRGs are used by Medicare and other payors to make payments to hospitals for inpatient stays.
- 💸 Transparency of both clinical logic going into DRG code determinations (and the price coming out) are frequently obfuscated by
All in all, CareQuery® leverages the comprehensive longitudinal record of patients to articulately arrive at a reliable DRG determination for inpatient visits, helping users to comprehensively look through the DRG lens, despite the DRG's traditional data lineage shortcomings.
Queries that source from DRG_TABLE table
What is in the DRG_TABLE table?
Results are returned as a json, pySpark DataFrame, or pandas DataFrame (default).
| feature | description | example |
|---|---|---|
| drg_code | Diagnosis related group (DRG) code. This code is based on your primary and secondary diagnoses, other conditions (comorbidities), age, sex, and necessary medical procedures. | 099 |
| drg_name | Descriptive name of the DRG code | non-bacterial infection of nervous system except viral meningitis without cc/mcc |
| drg_category | Medical Diagnostic Category MDC of the DRG | nervous system |
| drg_type | The type of diagnosis related group (DRG) | medical |
| drg_post_acute | Binary indicator of whether a DRG is post acute or not | False |
| drg_special | Binary indicator of whether a DRG is a special condition - particularly complex or expensive conditions that may require specialized care, longer hospital stays, and/or more expensive medications and procedures. | False |
| drg_weight | Represents the relative resources required to care for patients in that particular DRG. This CMS computed figure highlights a DRG's relative to the average resources used to treat cases in all other DRGs. | 1.3985 |
| los_gmean | The geometric mean length of stay corresponding to a DRG | 3.7 |
| los_mean | The arithmetic mean length of stay corresponding to a DRG | 4.6 |
Helper Function within the CareQuery API to help understand the underlying DRG_TABLE dataset.
# import package
from care_query.care_query import CareQuery
# instantiate and connect
cq = CareQuery(email = "your-email",
token = "your-api-token")
# return details
print(cq.glossary.table_detail('DRG_TABLE'))
Updated about 1 year ago