DRG — Diagnosis Related Group
Appears in ADT discharge messages and BAR (add billing account) messages. Follows DG1 segments.
The DRG segment contains the Diagnosis Related Group assignment for an inpatient stay, used for Medicare and managed care reimbursement. It carries the DRG code, severity information, and financial calculations.
Real-World Context
DRG is the payment bucket for inpatient billing. The DRG code determines the fixed payment amount under Medicare PPS. A wrong DRG assignment — usually due to incorrect ICD-10 coding or missing complication codes — is the most common cause of underpayment for complex cases. Always verify DRG against clinical documentation when reimbursement seems low.
Field Reference
Click any row to see the full description, common values, and troubleshooting tip.
| # | Field Name | Type | Req | Max Len | |
|---|---|---|---|---|---|
| 1 | Diagnostic Related Group | CNE | O | 705 | ▶ |
| 2 | DRG Assigned Date/Time | TS | O | 26 | ▶ |
| 3 | DRG Approval Indicator | ID | O | 1 | ▶ |
| 4 | DRG Grouper Review Code | IS | O | 2 | ▶ |
| 5 | Outlier Type | CE | O | 250 | ▶ |
| 6 | Outlier Days | NM | O | 3 | ▶ |
| 7 | Outlier Cost | CP | O | 12 | ▶ |
| 8 | DRG Payor | IS | O | 1 | ▶ |
| 9 | Outlier Reimbursement | CP | O | 9 | ▶ |
| 10 | Confidential Indicator | ID | O | 1 | ▶ |
| 11 | DRG Transfer Type | IS | O | 21 | ▶ |
| 12 | Name of Coder | XPN | O | 250 | ▶ |
| 13 | Grouping Status | CE | O | 250 | ▶ |
| 14 | PCCL Value Code | CE | O | 705 | ▶ |
| 15 | Effective Weight | NM | O | 6 | ▶ |
| 16 | Monetary Amount | MO | O | 20 | ▶ |
| 17 | Status Patient | IS | O | 20 | ▶ |
| 18 | Grouper Software Name | ST | O | 100 | ▶ |
| 19 | Grouper Software Version | ST | O | 100 | ▶ |
| 20 | Status Financial Calculation | IS | O | 20 | ▶ |
| 21 | Relative Discount/Surcharge | MO | O | 20 | ▶ |
| 22 | Basic Charge | MO | O | 20 | ▶ |
| 23 | Total Charge | MO | O | 20 | ▶ |
| 24 | Discount/Surcharge | MO | O | 20 | ▶ |
| 25 | Calculated Days | NM | O | 5 | ▶ |
| 26 | Status Admission | IS | O | 20 | ▶ |
| 27 | Grouper Version | ST | O | 10 | ▶ |
| 28 | Status Age From Production | IS | O | 20 | ▶ |
| 29 | PCCL Lower Bound | NM | O | 4 | ▶ |
| 30 | PCCL Upper Bound | NM | O | 4 | ▶ |
| 31 | Institutional Special Case Surcharge | MO | O | 20 | ▶ |
| 32 | Grain Indicator | IS | O | 1 | ▶ |
Example Segment
1DRG||282^Acute MI with MCC^CMS_DRG|20260315163000|Y|||C^Cost outlier|3|25000.00&USD|M|12500.00&USD|N||F||2.4567|12500.00^USD|I|3M_GROUPER|MS-DRG V41|||-500.00^USD|45000.00^USD|25000.00^USD|-2000.00^USD|5|E|V41
Related Segments
Used In Message Types
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