PBL-038
October 2022
Defining the Medicare Severity Diagnosis
Related Groups (MS-DRGs), Version 40.0
Each of the Medicare Severity Diagnosis Related Groups is defined by a particular set of patient
attributes which include principal diagnosis, specific secondary diagnoses, procedures, sex and
discharge status. The purpose of this chapter is to specify the patient attributes which define
each MS-DRG. This chapter is organized around the twenty-five Major Diagnostic Categories. For
each Major Diagnostic Category the following material is provided:
1. A logic table depicting the MS-DRG structure for the Major Diagnostic Category.
2. A listing of all the ICD-10-CM diagnoses assigned to the Major Diagnostic Category.
3. A detailed description of patient attributes which define each MS-DRG in the Major
Diagnostic Category.
The tree diagrams have been replaced with logic tables. Each logic table specifies in its columns
specific conditions which determine the MS-DRG assigned. The rows specify individual MS-DRGs.
Each cell in the logic table indicates whether a specific condition in the column is necessary for
the MS-DRG in the row to be assigned. The combination of the cells which are required for a
specific MS-DRG represent a complete description of the assignment logic for that MS-DRG.
In the sample logic table below, discharge status and the presence of either an MCC or CC will
define the MS-DRG assignment. With a discharge status indicating that patient was discharged
alive, the presence of an MCC would assign to MS-DRG 280, a CC would assign to MS-DRG 281,
while having neither would assign to MS-DRG 282. If the discharge status indicates the patient
died, an MCC would assign to MS-DRG 283, a CC would assign to MS-DRG 284, while having
neither an MCC or CC would assign to MS-DRG 285.
Table 1. Sample logic table
Acute Myocardial Infarction
[blank]
[blank]
[blank]
Discharged Alive
MCC
CC
DRG
Yes
Yes
[blank]
280
Yes
No
Yes
281
Yes
No
No
282
No
Yes
[blank]
283
No
No
Yes
284
No
No
No
285
1.
The description of the patient attributes which define each MS-DRG begins with a one-line
description of the MS-DRG. This description includes the MS-DRG number and a brief description
