SHPBN-2019-023 New DRG Mapping
Date: 05/10/19
Thank you for your partnership with Sunflower Health Plan. ICD-10-CM and Medicare Severity Diagnosis Related Groups (MS-DRG) are continuously monitored and revised by CMS. Because Inpatient Prospective Payment System (IPPS) hospitals are paid based on DRGs, additions, deletions, or alterations to MS DRGs can affect hospital claim submission protocols.
The increase of the MS-DRGs are for vaginal delivery, cesarean section procedures and antepartum care and procedures.
2019 updates went into effect October 1, 2018. Please see the related table below.
Mapping from Deleted DRG (FY18 v35 eff. 10/1/17) to New DRG (FY19 v36 eff. 10/1/18)
| DRG FY 2018 (v35 eff. 10/1/2017) |
| DRG FY 2019 (v36 eff. 10/1/2018) | |
|---|---|---|---|---|
Comments | DRG | DRG Title | DRG | DHG Title |
Deleted, mapped | 765 | CESAREAN SECTION W CC/MCC | 783 | CESAREAN SECTION W STERILIZATION W MCC |
784 | CESAREAN SECTION W STERILIZATION W CC | |||
786 | CESAREAN SECTION W/O STERILIZATION W MCC | |||
787 | CESAREAN SECTION W/O STERILIZATION W CC | |||
Deleted, mapped | 766 | CESAREAN SECTION W/O CC/MCC | 785 | CESAREAN SECTION W STERILIZATION W/O CC/MCC |
788 | CESAREAN SECTION W/O STERILIZATION W/O CC/MCC | |||
Deleted, mapped | 767 | VAGINAL DELIVERY W STERILIZATION &/OR D&C | 796 | VAGINAL DELIVERY W STERILIZATION/D&C W MCC |
797 | VAGINAL DELIVERY W STERILIZATION/D&C W CC | |||
798 | VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC | |||
Deleted, mapped | 774 | VAGINAL DELIVERY W COMPLICATING DIAGNOSES | 805 | VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC |
|
|
| 806 | VAGINAL DELIVERY W/O STERILIZATION/D&C W CC |
Deleted, mapped | 775 | VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES | 807 | VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC |
Deleted, mapped | 781 | OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS | 817 | OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC |
818 | OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC | |||
831 | OTHER ANTEPARTIJM DIAGNOSES W/O O.R. PROCEDURE W MCC | |||
832 | OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC | |||
Deleted, mapped | 782 | OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS | 819 | OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/0 CC/MCC |
833 | OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC | |||
Deleted | 777 | ECTOPIC PREGNANCY |
|
|
Deleted | 778 | THREATENED ABORTION |
|
|
Deleted | 780 | FALSE LABOR |
|
|
No change | 768 | VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C | 768 | VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C |
No change | 769 | POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE | 769 | POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE |
No change | 770 | ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY | 770 | ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY |
No change | 776 | POSTPARTIJM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE | 776 | POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE |
No change | 779 | ABORTION W/O D&C | 779 | ABORTION W/O D&C |
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Customer Service at 1-877-644-4623.