DRG Letter

Date: 03/29/19

Thank you for your partnership with PA Health & Wellness. 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. Please don’t hesitate to reach out to Provider Services with any questions you may have.

PA Health & Wellness: 844-626-6813

Allwell from PA Health & Wellness: 855-766-1456

Ambetter from PA Health & Wellness: 833-510-4727

DRG Codes

Comments	Old DRG	Old DRG Title	New DRG	New DRG Title
Deleted, Mapped	765	Cesarean Section with CC/MCC	783	Cesarean Section with Sterilization with MCC
			784	Cesarean Section with Sterilization with CC
			786	Cesarean Section without Sterilization with MCC
			787	Cesarean Section without Sterilization with CC
Deleted, Mapped	766	Cesarean without CC/MCC	785	Cesarean Section with Sterilization without CC/MCC
			788	Cesarean Section without Sterilization without CC/MCC
Deleted, Mapped	767	Vaginal delivery with Sterilization &/or D&C	796	Vaginal Delivery with Sterilization/D&C with MCC
			797	Vaginal Delivery with Sterilization/D&C with CC
			798	Vaginal Delivery with Sterilization/D&C without CC/MCC
Deleted, Mapped	774	Vaginal delivery with complicating diagnoses	805	Vaginal Delivery without Sterilization/D&C with MCC
			806	Vaginal Delivery without Sterilization/D&C with CC
Deleted, Mapped	775	Vaginal delivery without complicating diagnoses	807	Vaginal Delivery without Sterilization/D&C without CC/MCC
Deleted, Mapped	781	Other antepartum diagnoses with medical complications	817	Other antepartum diagnoses wtih OR Procedure with MCC
			818	Other antepartum diagnoses wtih OR Procedure with CC
			831	Other antepartum diagnoses wtihout OR Procedure with MCC
			832	Other antepartum diagnoses wtihout OR Procedure with CC
Deleted, Mapped	782	Other antepartum diagnoses without medical complications	819	Other antepartum diagnoses wtih OR Procedure without CC/MCC
			833	Other antepartum diagnoses wtihout OR Procedure without CC/MCC
Deleted	777	Ectopic pregnancy
Deleted	778	Threatened Abortion
Deleted	780	False Labor
No Change	768	Vaginal delivery with OR Proc Except Steril &/OR D&C	768	Vaginal delivery with OR Proc Except Steril &/OR D&C
No Change	769	Postpartum & Post Aortion Diagnoses with OR Procedure	769	Postpartum & Post Aortion Diagnoses with OR Procedure
No Change	770	Abortion with D&C, Aspiration Curettage or Hysterotomy	770	Abortion with D&C, Aspiration Curettage or Hysterotomy
No Change	776	Postpartum & Post abortion diagnoses without OR Procedure	776	Postpartum & Post abortion diagnoses without OR Procedure
No Change	779	Abortion without D&C	779	Abortion without D&C