Diagnosis Related Groupings

Diagnosis Related Groupings (DRGs) are broad categories of medical conditions used by hospitals and other providers to categorize the conditions for treatment purposes. For example, the CMS version MS-DRG categorizes approximately 17,000 ICD-9 codes into approximately 500 MS-DRGs. On the provider side, DRGs are used to allocate resources based on medical conditions.

When converting DRGs to ICD-10, it is extremely important to understand that the hospital inpatient setting is affected the most among all providers of care. A provider's current state of the use of technology, proficiency in documentation and coding, and degree to which legacy systems are present will have the greatest bearing on the time and difficulty to achieve compliance.

CMS Conversion Process for Mapping Medicare MS-DRGs to ICD-10

The conversion process for mapping ICD-9-based MS-DRGs to ICD-10-based MS-DRGs is underway:

• Conversion of MS-DRG ICD-9-based systems and processes to ICD-10-based systems and processes is facilitated by General Equivalence Mappings (GEMs)
• Whether coded in ICD-9 or ICD-10, the same patient will be assigned to the same MS-DRG
• Preliminary mapping of MS-DRGs to ICD-10 will be available October 1, 2009
• Final mapping of MS-DRGs to ICD-10 will be subject to the Notice of Proposed Rule Making (NPRM) process
• ICD-10 2009 update files will be available on the CMS web site
• Diagnosis GEMs will be located on NCHS web site