MS-DRG Coding Indicators

All information in this report is taken from the Medicare Provider Analysis and Review (MedPAR) file which is updated annually by CMS based on the federal fiscal year.  The file includes billing data for 100% of all Medicare fee-for-service claims (IPPS claims) for discharges during the twelve months ending September 30.  The report is consistent with CMS cell size suppression policies. Only Base MS-DRGs with more than ten cases are reported.

Medical Service categories are based on groupings of patient MS-DRGs.  The Base MS-DRGs in the report correspond to the Medical Service selected. MS-DRGs provide up to three levels of severity for a particular condition. A "Base" MS-DRG combines all levels of severity into a single category. The MS-DRG numbers listed are the individual MS-DRGs that have been combined into a Base MS-DRG for reporting. Individual MS-DRGs within a Base MS-DRG are differentiated according to the presence of a complication (CC) or a major complication (MCC). The descriptors of these CC/MCCs are removed when describing the Base MS-DRG.

Side-by-side statistics are reported in order to enable comparisons and benchmarking. The Hospital Statistics are for the hospital currently being reported. The Comparative Statistics are National Averages or a summarization of the Active List chosen. Each set of statistics includes:

Cases

total number of IPPS claims for the Base MS-DRG. IPPS claims are Medicare fee-for-service inpatient claims paid under the Inpatient Prospective Payment System.

CMI

The CMI is the average relative weight for all cases reported in a Base MS-DRG. MS-DRGs at lower severity levels have lower relative weights and MS-DRGs at higher severity levels have higher relative weights. The CMI provides an index of patient mix among levels of severity within a Base MS-DRG.

CC/MCC Rate

measures the incidence of CCs or MCCs within Base MS-DRGs that are affected by the presence of either or both types of complications (i.e. complications or major complications). The numerator is the number of cases in MS-DRGs effected defined by the presence of a CC or MCC. The denominator is the total number of cases in the Base MS-DRG. (Some MS-DRGs may not be effected by the presence of CCs or MCCs and consequently will not have rates calculated.)

MCC Rate

measures the incidence of MCCs within Base MS-DRGs that are effected by the presence of a major complication. The numerator is the number of cases in an MS-DRGs defined by the presence of an MCC. The denominator is the total number of cases in its Base MS-DRG. (Some MS-DRGs may not be effected by the presence an MCC and consequently will not have a rate calculated.)