What is a DRG?
There are lots of terms and acronyms in the medical industry that may be hard to understand at first glance. One of those acronyms, DRG, is a common acronym used in hospital settings for management to consider.
What Does DRG Stand For?
The term DRG stands for Diagnosis-Related Group. A Diagnosis-Related Group is actually a statistical system that is used in the medical industry to classify an inpatient into a group. This group is then used for the purposes of billing and payment. For example, there are more than 20 major body systems and 500 groups involved in the DRG classification system for Medicare reasons.
There are a lot of factors that go into the determination of a DRG group and payment amount. For one, the diagnoses involved must be considered as well as the resource that was used at the hospital to help treat the patient. Hospitals do, for the most part, get paid a fixed rate based on the DRG group that’s given to a patient.
What are Examples of DRG Codes?
There are lots of different DRG codes to help classify inpatients. Some of the most common include:
- Transient Ischemia
- Medical Back Problems
- Kidney and Urinary Tract Infections
- Miscellaneous Disorders of Nutrition
- Syncope and Collapse
- Back and Neck Proc. Ex. Spinal Fusion
- Chest Pain
- Esophagitis, Gastroent. and Miscellaneous Digest Disorder
- Cardicac Defbrillator Implant W/O Cardiac Cath.
All of these have different billing error rates, depending on the group.
How are DRG Audits Completed?
First, you have to have someone who supervises the DRG classification and auditing system. This person then goes through DRG auditor training to help them get up to speed on how to review.
These DRG audits take into account how the patient was diagnosed, how they were treated, and how the claim was coded afterward. All the auditing/review process does is ensure that the code that was billed for the diagnosis matches the care that the patient actually got.
An example of this might be a person that’s admitted to the hospital because they have low blood pressure and were feeling dizzy. Maybe at the same time, it’s found that the client actually is dehydrated and has acute renal failure. When the code is first submitted, the code might have come in for low blood pressure as the diagnosis, but after a review, it’s clear that the condition was more serious than that and the initial code can be replaced with that actual diagnosis.