I R PInnovative Resources for Payors
                               
Medicare DRGs Effective 10/1/2005 - 9/30/2006
Source: Federal Register Friday, August 12, 2005
[[Page 47617]]
TABLE 5.--LIST OF DIAGNOSIS-RELATED GROUPS (DRGs), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND
  ARTHIMETIC MEAN LENGTH OF STAY (LOS)      
        RELATIVE GEOMETRIC ARITHMETIC  
DRG MDC TYPE DRG TITLE WEIGHTS MEAN LOS MEAN LOS  
1 1 SURG CRANIOTOMY AGE >17 W CC 3.4347 7.6000 10.1
2 1 SURG CRANIOTOMY AGE >17 W/O CC 1.9587 3.5000 4.6
3 1 SURG CRANIOTOMY AGE 0-17 1.986 12.7000 12.7
4 1 SURG NO LONGER VALID 0 0.0000 0.0
5 1 SURG NO LONGER VALID 0 0.0000 0.0
6 1 SURG CARPAL TUNNEL RELEASE 0.7878 2.2000 3.0
7 1 SURG PERIPH & CRANIAL NERVE & OTHER 2.6978 6.7000 9.7
NERV SYST PROC W CC
8 1 SURG PERIPH & CRANIAL NERVE & OTHER 1.5635 2.0000 3.0
NERV SYST PROC W/O CC
9 1 MED SPINAL DISORDERS & INJURIES 1.4045 4.5000 6.4
10 1 MED NERVOUS SYSTEM NEOPLASMS W CC 1.2222 4.6000 6.2
11 1 MED NERVOUS SYSTEM NEOPLASMS W/O CC 0.8736 2.9000 3.8
12 1 MED DEGENERATIVE NERVOUS SYSTEM 0.8998 4.3000 5.5
DISORDERS
13 1 MED MULTIPLE SCLEROSIS & CERE- 0.8575 4.0000 5.0
BELLAR ATAXIA
14 1 MED INTRACRANIAL HEMORRHAGE OR 1.2456 4.5000 5.8
CEREBRAL INFARCTION
15 1 MED NONSPECIFIC CVA & PRECEREBRAL 0.9421 3.7000 4.6
OCCLUSION W/O INFARCT
16 1 MED NONSPECIFIC CEREBROVASCULAR 1.3351 5.0000 6.5
DISORDERS W CC
17 1 MED NONSPECIFIC CEREBROVASCULAR 0.7229 2.5000 3.2
DISORDERS W/O CC
18 1 MED CRANIAL & PERIPHERAL NERVE DIS- 0.9903 4.1000 5.3
ORDERS W CC
19 1 MED CRANIAL & PERIPHERAL NERVE DIS- 0.7077 2.7000 3.5
ORDERS W/O CC
20 1 MED NERVOUS SYSTEM INFECTION EX- 2.7865 8.0000 10.4
CEPT VIRAL MENINGITIS
21 1 MED VIRAL MENINGITIS 1.4451 4.9000 6.3
22 1 MED HYPERTENSIVE ENCEPHALOPATHY 1.1304 4.0000 5.2
23 1 MED NONTRAUMATIC STUPOR & COMA 0.7712 3.0000 3.9
24 1 MED SEIZURE & HEADACHE AGE >17 W 0.997 3.6000 4.8
CC
25 1 MED SEIZURE & HEADACHE AGE >17 W/O 0.618 2.5000 3.1
CC
26 1 MED SEIZURE & HEADACHE AGE 0-17 1.8191 3.4000 6.3
27 1 MED TRAUMATIC STUPOR & COMA, COMA 1.3531 3.2000 5.2
>1 HR
28 1 MED TRAUMATIC STUPOR & COMA, COMA 1.3353 4.4000 5.9
<1 HR AGE >17 W CC
29 1 MED TRAUMATIC STUPOR & COMA, COMA 0.7212 2.6000 3.4
<1 HR AGE >17 W/O CC
30 1 MED TRAUMATIC STUPOR & COMA, COMA 0.3359 2.0000 2.0
<1 HR AGE 0-17
31 1 MED CONCUSSION AGE >17 W CC 0.9567 3.0000 4.0
32 1 MED CONCUSSION AGE >17 W/O CC 0.6194 1.9000 2.4
33 1 MED CONCUSSION AGE 0-17 0.2109 1.6000 1.6
34 1 MED OTHER DISORDERS OF NERVOUS 1.0062 3.7000 4.8
SYSTEM W CC
35 1 MED OTHER DISORDERS OF NERVOUS 0.6241 2.4000 3.0
SYSTEM W/O CC
36 2 SURG RETINAL PROCEDURES 0.7288 1.3000 1.6
37 2 SURG ORBITAL PROCEDURES 1.1858 2.7000 4.2
38 2 SURG PRIMARY IRIS PROCEDURES 0.6975 2.5000 3.5
39 2 SURG LENS PROCEDURES WITH OR WITH- 0.7108 1.7000 2.4
OUT VITRECTOMY
40 2 SURG EXTRAOCULAR PROCEDURES EX- 0.9627 3.0000 4.1
CEPT ORBIT AGE >17
41 2 SURG EXTRAOCULAR PROCEDURES EX- 0.3419 1.6000 1.6
CEPT ORBIT AGE 0-17
42 2 SURG INTRAOCULAR PROCEDURES EX- 0.7852 2.0000 2.8
CEPT RETINA, IRIS & LENS
43 2 MED HYPHEMA 0.6141 2.4000 3.1
44 2 MED ACUTE MAJOR EYE INFECTIONS 0.6874 3.9000 4.8
45 2 MED NEUROLOGICAL EYE DISORDERS 0.7474 2.5000 3.1
46 2 MED OTHER DISORDERS OF THE EYE 0.7524 3.2000 4.2
AGE >17 W CC
47 2 MED OTHER DISORDERS OF THE EYE 0.5203 2.3000 2.9
AGE >17 W/O CC
48 2 MED OTHER DISORDERS OF THE EYE 0.3012 2.9000 2.9
AGE 0-17
49 3 SURG MAJOR HEAD & NECK PROCEDURES 1.6361 3.1000 4.4
50 3 SURG SIALOADENECTOMY 0.869 1.5000 1.8
51 3 SURG SALIVARY GLAND PROCEDURES EX- 0.8809 1.9000 2.8
CEPT SIALOADENECTOMY
52 3 SURG CLEFT LIP & PALATE REPAIR 0.8348 1.5000 1.9
53 3 SURG SINUS & MASTOID PROCEDURES 1.3269 2.4000 3.9
AGE >17
54 3 SURG SINUS & MASTOID PROCEDURES 0.4882 3.2000 3.2
AGE 0-17
55 3 SURG MISCELLANEOUS EAR, NOSE, 0.9597 2.0000 3.1
MOUTH & THROAT PROCEDURES
56 3 SURG RHINOPLASTY 0.8711 1.8000 2.6
57 3 SURG T&A PROC, EXCEPT TONSILLECTOMY 1.0428 2.3000 3.6
&/OR ADENOIDECTOMY ONLY, AGE
>17
58 3 SURG T&A PROC, EXCEPT TONSILLECTOMY 0.2772 1.5000 1.5
&/OR ADENOIDECTOMY ONLY, AGE
0-17
59 3 SURG TONSILLECTOMY &/OR 0.8082 1.8000 2.6
ADENOIDECTOMY ONLY, AGE >17
60 3 SURG TONSILLECTOMY &/OR 0.211 1.5000 1.5
ADENOIDECTOMY ONLY, AGE 0-17
61 3 SURG MYRINGOTOMY W TUBE INSERTION 1.2867 3.3000 5.4
AGE >17
62 3 SURG MYRINGOTOMY W TUBE INSERTION 0.2989 1.3000 1.3
AGE 0-17
63 3 SURG OTHER EAR, NOSE, MOUTH & 1.3983 3.0000 4.5
THROAT O R PROCEDURES
64 3 MED EAR, NOSE, MOUTH & THROAT MA- 1.1663 4.1000 6.1
LIGNANCY
65 3 MED DYSEQUILIBRIUM 0.5991 2.3000 2.8
66 3 MED EPISTAXIS 0.5958 2.4000 3.1
67 3 MED EPIGLOTTITIS 0.7725 2.9000 3.7
68 3 MED OTITIS MEDIA & URI AGE >17 W CC 0.6611 3.2000 4.0
69 3 MED OTITIS MEDIA & URI AGE >17 W/O 0.485 2.5000 3.0
CC
70 3 MED OTITIS MEDIA & URI AGE 0-17 0.421 2.1000 2.3
71 3 MED LARYNGOTRACHEITIS 0.7524 3.2000 4.0
72 3 MED NASAL TRAUMA & DEFORMITY 0.7449 2.6000 3.4
73 3 MED OTHER EAR, NOSE, MOUTH & 0.8527 3.3000 4.4
THROAT DIAGNOSES AGE >17
74 3 MED OTHER EAR, NOSE, MOUTH & 0.3398 2.1000 2.1
THROAT DIAGNOSES AGE 0-17
75 4 SURG MAJOR CHEST PROCEDURES 3.0732 7.6000 9.9
76 4 SURG OTHER RESP SYSTEM O R PROCE- 2.883 8.4000 11.1
DURES W CC
77 4 SURG OTHER RESP SYSTEM O R PROCE- 1.1857 3.3000 4.7
DURES W/O CC
78 4 MED PULMONARY EMBOLISM 1.2427 5.4000 6.4
79 4 MED RESPIRATORY INFECTIONS & IN- 1.6238 6.7000 8.5
FLAMMATIONS AGE >17 W CC
80 4 MED RESPIRATORY INFECTIONS & IN- 0.8947 4.4000 5.5
FLAMMATIONS AGE >17 W/O CC
81 4 MED RESPIRATORY INFECTIONS & IN- 1.5383 6.1000 6.1
FLAMMATIONS AGE 0-17
82 4 MED RESPIRATORY NEOPLASMS 1.3936 5.1000 6.8
83 4 MED MAJOR CHEST TRAUMA W CC 0.9828 4.2000 5.3
84 4 MED MAJOR CHEST TRAUMA W/O CC 0.5799 2.6000 3.2
85 4 MED PLEURAL EFFUSION W CC 1.2405 4.8000 6.3
86 4 MED PLEURAL EFFUSION W/O CC 0.6974 2.8000 3.6
87 4 MED PULMONARY EDEMA & RES- 1.3654 4.9000 6.4
PIRATORY FAILURE
88 4 MED CHRONIC OBSTRUCTIVE PUL- 0.8778 4.0000 4.9
MONARY DISEASE
89 4 MED SIMPLE PNEUMONIA & PLEURISY 1.032 4.7000 5.7
AGE >17 W CC
90 4 MED SIMPLE PNEUMONIA & PLEURISY 0.6104 3.2000 3.8
AGE >17 W/O CC
91 4 MED SIMPLE PNEUMONIA & PLEURISY 0.8124 3.4000 4.4
AGE 0-17
92 4 MED INTERSTITIAL LUNG DISEASE W CC 1.1853 4.8000 6.1
93 4 MED INTERSTITIAL LUNG DISEASE W/O CC 0.715 3.1000 3.9
94 4 MED PNEUMOTHORAX W CC 1.1354 4.6000 6.2
95 4 MED PNEUMOTHORAX W/O CC 0.6035 2.9000 3.6
96 4 MED BRONCHITIS & ASTHMA AGE >17 W 0.7303 3.6000 4.4
CC
97 4 MED BRONCHITIS & ASTHMA AGE >17 W/O 0.5364 2.8000 3.4
CC
98 4 MED BRONCHITIS & ASTHMA AGE 0-17 0.556 3.7000 3.7
99 4 MED RESPIRATORY SIGNS & SYMPTOMS 0.7094 2.4000 3.1
W CC
100 4 MED RESPIRATORY SIGNS & SYMPTOMS 0.5382 1.7000 2.1
W/O CC
101 4 MED OTHER RESPIRATORY SYSTEM DIAG- 0.8733 3.3000 4.3
NOSES W CC
102 4 MED OTHER RESPIRATORY SYSTEM DIAG- 0.5402 2.0000 2.5
NOSES W/O CC
103 SURG HEART TRANSPLANT OR IMPLANT OF 18.5617 23.7000 37.7
HEART ASSIST SYSTEM
104 5 SURG CARDIAC VALVE & OTH MAJOR 8.2201 12.7000 14.9
CARDIOTHORACIC PROC W CARD
CATH
105 5 SURG CARDIAC VALVE & OTH MAJOR 6.0192 8.4000 10.2
CARDIOTHORACIC PROC W/O
CARD CATH
106 5 SURG CORONARY BYPASS W PTCA 7.0346 9.5000 11.2
107 5 SURG NO LONGER VALID 0 13.5000 13.5
108 5 SURG OTHER CARDIOTHORACIC PROCE- 5.8789 8.6000 11.0
DURES
109 5 SURG NO LONGER VALID 0 12.1000 12.1
110 5 SURG MAJOR CARDIOVASCULAR PROCE- 3.8417 5.7000 8.4
DURES W CC
111 5 SURG MAJOR CARDIOVASCULAR PROCE- 2.484 2.6000 3.4
DURES W/O CC
112 5 SURG NO LONGER VALID 0 0.0000