New DRG codes for C-sections and vaginal deliveries
Date: 04/03/19
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.
Recently, CMS announced changes to the Diagnosis Related Group (DRG) coding that impacts billing for C-Sections and vaginal deliveries. In order to remain compliant with CMS coding guidelines, we are updating our billing instructions for these procedures.
Please see the enclosed complete schedule of DRG codes impacted by this change, along with updated codes and titles.
Comments | Old DRG | Old DRG Title | New DRG | New DRG 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 ANTEPARTUM 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/O CC/MCC |
833 | OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC | |||
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Deleted | 777 | ECTOPIC PREGNANCY | ||
Deleted | 778 | THREATENED ABORTION | ||
Deleted | 780 | FALSE LABOR | ||
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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 DIANOSES W O.R. PROCEDURE | 769 | POSTPARTUM & POST ABORTION DIANOSES 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 | POSTPARTUM & 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 |