What elements affect DRGs

There are four main elements that are taken into consideration by a DRG grouper software to generate a DRG. These four elements are

1.Surgical procedure codes
3. Discharge Status
4. Patient's age
5. Patient's gender

The surgical procedure codes, the diagnosis, and the patient's age and gender are used to determine the correct DRG assignments. If any one of them is coded incorrectly on the claim form, the resulting DRG will l be wrong. One can understand that primary procedure and diagnosis codes will affect DRGs, but how does patient's age and gender affect DRG?

Some DRG weights are age dependent. For example, if a person younger than 17 is hospitalized for cellulitis, the DRG is 279 and the weight is .7785. If the patient is older then 17 then the DRG is 277 with weight of 0.8877. Patients gender also plays a role if you assign a DRG for pregnancy and the patient is a male. The claim will be rejected.

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