Healthcare Insights
Top 25 DRGs by diagnosis volume
Diagnosis-related groups (DRGs) categorize patients and reflect Medicare fees and reimbursement for hospital stays. Patients are placed into a DRG category based on their primary diagnosis, procedures performed, and discharge status. DRGs ensure that Medicare reimbursements reflect a hospital’s case-mix complexity or the types and severity of patients they most often treat.
The Definitive Healthcare HospitalView product tracks Medicare inpatient procedures for more than 5,000 U.S. hospitals. DRGs are provided through the Medicare Standard Analytic Files (SAF). Complete calendar year data is typically released each fall for the preceding year. Below, we list the DRGs by total volume for 2023.
| Rank | DRG code | Description | Percent of total DRG diagnoses | Explore dataset |
|---|---|---|---|---|
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 8.60% | Explore |
| 2 | 291 | HEART FAILURE & SHOCK W MCC | 4.50% | Explore |
| 3 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 2.50% | Explore |
| 4 | 885 | PSYCHOSES | 2.00% | Explore |
| 5 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 1.80% | Explore |
| 6 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 1.40% | Explore |
| 7 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 1.40% | Explore |
| 8 | 853 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | 1.40% | Explore |
| 9 | 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC | 1.20% | Explore |
| 10 | 682 | RENAL FAILURE W MCC | 1.20% | Explore |
| 11 | 683 | RENAL FAILURE W CC | 1.20% | Explore |
| 12 | 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | 1.10% | Explore |
| 13 | 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | 1.10% | Explore |
| 14 | 698 | OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC | 1.10% | Explore |
| 15 | 689 | KIDNEY & URINARY TRACT INFECTIONS W MCC | 1.10% | Explore |
| 16 | 640 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC | 1.10% | Explore |
| 17 | 378 | G.I. HEMORRHAGE W CC | 1.00% | Explore |
| 18 | 64 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC | 1.00% | Explore |
| 19 | 57 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC | 1.00% | Explore |
| 20 | 65 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC | 1.00% | Explore |
| 21 | 377 | G.I. HEMORRHAGE W MCC | 0.90% | Explore |
| 22 | 641 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC | 0.80% | Explore |
| 23 | 309 | CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC | 0.80% | Explore |
| 24 | 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC | 0.80% | Explore |
| 25 | 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC | 0.80% | Explore |
Fig. 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for 2023.
What are the most common DRGs?
The most common DRG code tracked in our database in 2023 was 871, which is used for septicemia or severe sepsis without mechanical ventilation for 96+ hours with major complications or comorbidities. It accounted for 8.6% of all DRG diagnoses in 2023.
This DRG typically applies to patients diagnosed with severe systemic infections or sepsis that require intensive medical care but do not involve extended mechanical ventilation. Major complications or comorbidities refer to additional serious conditions that can affect the patient's care and increase the complexity of treatment.
Sepsis is also a top infectious disease.
Heart failure is the second top DRG code, which accounted for 4.5% of all diagnoses in 2023. This DRG applies to patients who are admitted for heart failure or shock and have major complications or comorbidities that make their treatment more complex. Major complications or comorbidities can include severe infections, kidney failure, or other serious conditions that complicate the care required for these patients.
Finally, DRG code 177 was the third most common diagnosis of 2023, comprising 2.5% of diagnoses. Code 177 is used for patients with serious respiratory infections, such as pneumonia, bronchitis, or other inflammatory conditions of the lungs, who also have major complications or comorbidities. These additional conditions significantly affect the complexity of care, potentially requiring more intensive treatment or longer hospital stays.
How is a DRG calculated?
Each DRG is given a weighted value relative to the time and resources required to administer care for the average patient effectively. This value is multiplied by a preset dollar amount that reflects the hospital’s status (for example, teaching hospitals have higher reimbursements) and service area demographics (such as average local wage levels) to find the total reimbursement amount.
DRG assignment is based on:
- Principal diagnosis
- Secondary diagnoses
- Patient age and sex
- Discharge status
- Comorbidities and complications
What is an MS-DRG?
The Medicare Severity DRG (MS-DRG) system further differentiates each patient’s severity of illness and associated care costs. The original DRG case-mix system was limited to one or two levels of severity, while most MS-DRGs have three levels of severity. This allows hospitals to assess a patient’s needs more accurately without fear of hampering reimbursement.
MS-DRG severity categories include:
- Complication/comorbidity (CC)
- Major complication/comorbidity (MMC)
- Non-complication/comorbidity (Non-CC)
Learn more
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