CMS Medicare Severity Diagnosis Related Grouper (MS-DRG) (formerly CMS DRG Grouper) and Medicare Code Editor

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	CMS Medicare Severity Diagnosis Related Groups (MS-DRG) Grouper (Version 25.1)
	CMS Medicare Severity Diagnosis Related Grouper Software with Medicare Code Editor (MS-DRG/MCE) (Version 25.1)
	Medicare Code Editor (MCE) for Hospital Billing (Version 24.1)
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Updated Version 25.1 adds a new patient discharge status code 70 and a definition change to existing patient discharge status code 05.

The Centers for Medicare and Medicaid Services Medicare Severity Diagnosis Related Groups (MS-DRG) Grouper software and the Medicare Code Editor (MCE) software, formerly distributed by 3M, are available from NTIS.

NOTICE: For claims with a discharge date of 10/01/07 through 03/31/08, MS-DRG v 25.0 should be used. Although new discharge status (DS) 70 does not impact any DRG assignments, for claims with a discharge date of 04/01/08 through 09/30/08, MS-DRG 25.1 should be used. This will ensure that DS 70 is properly recognized as valid. If a claim with a DS 70 is used in MS-DRG 25.0, it will not be recognized and could lead to inaccurate grouping.

 

CMS Medicare Severity Diagnosis Related Groups (MS-DRG) Grouper (Version 25.1)

 

Price: $660
(Price outside the U.S., Canada, and Mexico $1,320)
Order number: PB2008-500034 (PB2007-500044 version 25.0 - Call Sales Desk at 1-800-553-6847 to order)
Media type: Software on Magnetic Tape

 

 

 

Additional Information about Version 25.1:

1. There were no changes to diagnoses and procedure codes. The diagnoses and procedure included in MS-DRG v25.1 and MCE v24.1 were effective October 1, 2007.
2. There were no additions, deletions or modifications to DRG logic.
3. There are no additions, deletion or modifications to MCE edits.
4. Existing discharge status code 05 has a definition change effective 4/1/08: Discharged/transferred to a designated cancer center or children’s hospital.
5. A new discharge status 70 was added effective 4/1/08: Discharge/transfer to another type of health care institution not defined elsewhere in the code list.

 

CMS Diagnosis Related Groups (DRG) Grouper (Version 25.1)
Product	Price*	Order
3480 Magnetic Cartridge	$660* (Price outside the U.S., Canada and Mexico is $1320)
6250bpi Magnetic Tape	$660* (Price outside the U.S., Canada and Mexico is $1320)
1600bpi Magnetic Tape	$660* (Price outside the U.S., Canada and Mexico is $1320)
* A $5 handling fee is added to each total order for U.S., Canada, and Mexico; $12.50 for all others.

 

The Medicare Severity Diagnosis Related Groups (MS-DRGs) Grouper software classifies hospital case types into groups expected to have similar hospital resource use.  Medicare uses this classification to pay for inpatient hospital care.  Hospitals are paid a fixed price by Diagnosis Related Group (DRG) for treating Medicare patients.  The groupings are based on diagnoses, procedures, other demographic information, and the presence of complications or co-morbidities.

Note:  Starting with Version 25, the grouper name has changed from the Centers of Medicare and Medicaid Services (CMS) DRGs to Medicare Severity DRGs (MS-DRGs), also referred to as MS grouper.

Minimally, the grouper consists of four programs.  One of the programs consists of tables, which contain information for all valid diagnoses, procedures, and DRGs.  The diagnosis and procedure tables were prepared from the CPHA ICD-9-CM codes and abbreviated description tape (December 1979 revision) and the additional codes documented in the Federal Registers detailed final grouper changes for versions 4.0 through 25.0.  Plain text (EBCDIC) versions of the tables are embedded in the programs are supplied as well.

 

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CMS Medicare Severity Diagnosis Related Grouper (MS-DRG) with Medicare Code Editor (MS-DRG/MCE) (Version 25.1)

Price: $300
(Price outside the U.S., Canada, and Mexico $600)
Order number: PB2008-500036 (PB2007-500046 -- Version 25.0 - call Sales Desk at 1-800-553-6847 to order)
(prior issues PB2006-500058, PB2005500164 and PB2004500158)
Media Type: CD-ROM

Additional Information about Version 25.1:

1. There were no changes to diagnoses and procedure codes. The diagnoses and procedure included in MS-DRG v25.1 and MCE v24.1 were effective October 1, 2007.
2. There were no additions, deletions or modifications to DRG logic.
3. There are no additions, deletion or modifications to MCE edits.
4. Existing discharge status code 05 has a definition change effective 4/1/08: Discharged/transferred to a designated cancer center or children’s hospital.
5. A new discharge status 70 was added effective 4/1/08: Discharge/transfer to another type of health care institution not defined elsewhere in the code list.

The Medicare Severity Diagnosis Related Grouper with Medicare Code Editor (MS-CMSG/MCE) software edits medical record data to help identify coding errors, and inconsistencies between clinical data and coding. This release of the MS Grouper with MCE software for Windows-based personal computers supports Versions 16.0 through 25.0 of the grouper.  To process a claim using a CMS grouper prior to version 16.1, you must use the earlier version of CMS Grouper with MCE software that runs under DOS.

Note:  Starting with Version 25, the grouper name has changed from the Centers of Medicare and Medicaid Services (CMS) DRGs to Medicare Severity DRGs (MS-DRGs), also referred to as MS grouper.

The software:

• Assigns the medical record to a Major Diagnostic Category (MDC) and a Diagnosis Related Group (DRG).
• Displays clinical edits that identify inconsistencies after evaluating a patient's principal diagnosis, any secondary diagnoses, surgical procedures, and discharge status for possible errors.
• Displays the cost weight associated with the assigned DRG for each patient record.
• Automatically calls the appropriate MS grouper to process the claim based on the groupers installed and the discharge data entered on the patient record.
• Processes medical record data either from a MS-DOS batch file or interactively in a Windows environment.

 

Medicare Code Editor (MCE) for Hospital Billing (Version 24.1)

Price: $480
(Price outside the U.S., Canada, and Mexico $960)
Order number: PB2008-500035 (PB2007-500045 Version 24.0 -- Call Sales Desk 1-800-553-6847 to order)
Media Type: Software on Magnetic Tape

 

Medicare Code Editor (MCE) for Hospital Billing (Version 24.0)
Product	Price*	Order
3480 Magnetic Cartridge	$480* (Price outside the U.S., Canada and Mexico is $960)
6250bpi Magnetic Tape	$480* (Price outside the U.S., Canada and Mexico is $960)
1600bpi Magnetic Tape	$480* (Price outside the U.S., Canada and Mexico is $960)
* A $5 handling fee is added to each total order for U.S., Canada, and Mexico; $12.50 for all others.

The Medicare Code Editor (MCE) software detects and reports errors in the coding of Medicare claims data. While it identifies and indicates the nature of the error, it does not correct the error. A particular error condition is associated with each type of coding error identified by MCE. When MCE identifies an error in a medical claim, it prints a summary of the claim information along with the error message identifying the problem.