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DRG Scenario Tool

December 01, 2014

The coding and translation sub-workgroup is pleased to release the first iteration of the DRG scenario tool for general consumption. This includes 33 different inpatient scenarios, submitted by a variety of sources, that suggest a potential DRG or payment shift between ICD-9 and ICD-10. 

The current scenarios have been grouped based on the MSDRG grouper Version 31 for ICD-9 and the pilot MSDRG grouper 31 for ICD-10.  Alterations in payment rate in the scenarios will recalculate payment amounts in the tool.  Other grouper versions may be used for future scenarios as they are submitted by other contributors.  Where possible using the same grouper and version may allow for are more stable comparisons of scenarios.

 The first tab contains some basic metadata about the scenarios including:

  • An Id for the scenarios that is linked to the scenario tab
  • A short description or name for the scenario
  • The contributor of the scenarios
  • The clinical domain (condition of procedure type)
  • The DRGs impacted
  • The type of shift
  • The status of review – initially all scenarios are listed as pending review these will be marked as “Reviewed – Sub-workgroup” after the sub-workgroup comments and question have been addressed.  Some of these will be considered resolved or reported, or not relevant and will be removed from the list at some point.

The intent is to continue to add scenarios from a variety of sources where there is an illustration of a case that may result in a DRG shift during the transition between ICD-9 and ICD-10 for any number of reasons.  We will continue to review, update and add new scenarios in ongoing versions of this document periodically.  Scenarios that are essentially the same as existing scenarios will not be added to avoid redundancy wherever possible.

Our hope is that this will provide education material for the industry in preparation for clinical documentation  and coding training as well as to assist in identifying potential mapping and grouper issues.  Additional other organization will be able to use this worksheet as a way of capturing their own DRG shift concerns (and hopefully share those scenarios with us to add to the base).


Contact Information

Samantha Holvey