ICD-10-CM/PCS MS-DRG v38.0 R1 Definitions Manual (2024)

A690Necrotizing ulcerative stomatitisB002Herpesviral gingivostomatitis and pharyngotonsillitisB370Candidal stomatitisB3783Candidal cheilitisD100Benign neoplasm of lipD101Benign neoplasm of tongueD102Benign neoplasm of floor of mouthD1030Benign neoplasm of unspecified part of mouthD1039Benign neoplasm of other parts of mouthD165Benign neoplasm of lower jaw boneK000AnodontiaK001Supernumerary teethK002Abnormalities of size and form of teethK003Mottled teethK004Disturbances in tooth formationK005Hereditary disturbances in tooth structure, not elsewhere classifiedK006Disturbances in tooth eruptionK007Teething syndromeK008Other disorders of tooth developmentK009Disorder of tooth development, unspecifiedK010Embedded teethK011Impacted teethK023Arrested dental cariesK0251Dental caries on pit and fissure surface limited to enamelK0252Dental caries on pit and fissure surface penetrating into dentinK0253Dental caries on pit and fissure surface penetrating into pulpK0261Dental caries on smooth surface limited to enamelK0262Dental caries on smooth surface penetrating into dentinK0263Dental caries on smooth surface penetrating into pulpK027Dental root cariesK029Dental caries, unspecifiedK030Excessive attrition of teethK031Abrasion of teethK032Erosion of teethK033Pathological resorption of teethK034HypercementosisK035Ankylosis of teethK036Deposits [accretions] on teethK037Posteruptive color changes of dental hard tissuesK0381Cracked toothK0389Other specified diseases of hard tissues of teethK039Disease of hard tissues of teeth, unspecifiedK0401Reversible pulpitisK0402Irreversible pulpitisK041Necrosis of pulpK042Pulp degenerationK043Abnormal hard tissue formation in pulpK044Acute apical periodontitis of pulpal originK045Chronic apical periodontitisK046Periapical abscess with sinusK047Periapical abscess without sinusK048Radicular cystK0490Unspecified diseases of pulp and periapical tissuesK0499Other diseases of pulp and periapical tissuesK0500Acute gingivitis, plaque inducedK0501Acute gingivitis, non-plaque inducedK0510Chronic gingivitis, plaque inducedK0511Chronic gingivitis, non-plaque inducedK0520Aggressive periodontitis, unspecifiedK05211Aggressive periodontitis, localized, slightK05212Aggressive periodontitis, localized, moderateK05213Aggressive periodontitis, localized, severeK05219Aggressive periodontitis, localized, unspecified severityK05221Aggressive periodontitis, generalized, slightK05222Aggressive periodontitis, generalized, moderateK05223Aggressive periodontitis, generalized, severeK05229Aggressive periodontitis, generalized, unspecified severityK0530Chronic periodontitis, unspecifiedK05311Chronic periodontitis, localized, slightK05312Chronic periodontitis, localized, moderateK05313Chronic periodontitis, localized, severeK05319Chronic periodontitis, localized, unspecified severityK05321Chronic periodontitis, generalized, slightK05322Chronic periodontitis, generalized, moderateK05323Chronic periodontitis, generalized, severeK05329Chronic periodontitis, generalized, unspecified severityK054PeriodontosisK055Other periodontal diseasesK056Periodontal disease, unspecifiedK06010Localized gingival recession, unspecifiedK06011Localized gingival recession, minimalK06012Localized gingival recession, moderateK06013Localized gingival recession, severeK06020Generalized gingival recession, unspecifiedK06021Generalized gingival recession, minimalK06022Generalized gingival recession, moderateK06023Generalized gingival recession, severeK061Gingival enlargementK062Gingival and edentulous alveolar ridge lesions associated with traumaK063Horizontal alveolar bone lossK068Other specified disorders of gingiva and edentulous alveolar ridgeK069Disorder of gingiva and edentulous alveolar ridge, unspecifiedK080Exfoliation of teeth due to systemic causesK08101Complete loss of teeth, unspecified cause, class IK08102Complete loss of teeth, unspecified cause, class IIK08103Complete loss of teeth, unspecified cause, class IIIK08104Complete loss of teeth, unspecified cause, class IVK08109Complete loss of teeth, unspecified cause, unspecified classK08111Complete loss of teeth due to trauma, class IK08112Complete loss of teeth due to trauma, class IIK08113Complete loss of teeth due to trauma, class IIIK08114Complete loss of teeth due to trauma, class IVK08119Complete loss of teeth due to trauma, unspecified classK08121Complete loss of teeth due to periodontal diseases, class IK08122Complete loss of teeth due to periodontal diseases, class IIK08123Complete loss of teeth due to periodontal diseases, class IIIK08124Complete loss of teeth due to periodontal diseases, class IVK08129Complete loss of teeth due to periodontal diseases, unspecified classK08131Complete loss of teeth due to caries, class IK08132Complete loss of teeth due to caries, class IIK08133Complete loss of teeth due to caries, class IIIK08134Complete loss of teeth due to caries, class IVK08139Complete loss of teeth due to caries, unspecified classK08191Complete loss of teeth due to other specified cause, class IK08192Complete loss of teeth due to other specified cause, class IIK08193Complete loss of teeth due to other specified cause, class IIIK08194Complete loss of teeth due to other specified cause, class IVK08199Complete loss of teeth due to other specified cause, unspecified classK0820Unspecified atrophy of edentulous alveolar ridgeK0821Minimal atrophy of the mandibleK0822Moderate atrophy of the mandibleK0823Severe atrophy of the mandibleK0824Minimal atrophy of maxillaK0825Moderate atrophy of the maxillaK0826Severe atrophy of the maxillaK083Retained dental rootK08401Partial loss of teeth, unspecified cause, class IK08402Partial loss of teeth, unspecified cause, class IIK08403Partial loss of teeth, unspecified cause, class IIIK08404Partial loss of teeth, unspecified cause, class IVK08409Partial loss of teeth, unspecified cause, unspecified classK08411Partial loss of teeth due to trauma, class IK08412Partial loss of teeth due to trauma, class IIK08413Partial loss of teeth due to trauma, class IIIK08414Partial loss of teeth due to trauma, class IVK08419Partial loss of teeth due to trauma, unspecified classK08421Partial loss of teeth due to periodontal diseases, class IK08422Partial loss of teeth due to periodontal diseases, class IIK08423Partial loss of teeth due to periodontal diseases, class IIIK08424Partial loss of teeth due to periodontal diseases, class IVK08429Partial loss of teeth due to periodontal diseases, unspecified classK08431Partial loss of teeth due to caries, class IK08432Partial loss of teeth due to caries, class IIK08433Partial loss of teeth due to caries, class IIIK08434Partial loss of teeth due to caries, class IVK08439Partial loss of teeth due to caries, unspecified classK08491Partial loss of teeth due to other specified cause, class IK08492Partial loss of teeth due to other specified cause, class IIK08493Partial loss of teeth due to other specified cause, class IIIK08494Partial loss of teeth due to other specified cause, class IVK08499Partial loss of teeth due to other specified cause, unspecified classK0850Unsatisfactory restoration of tooth, unspecifiedK0851Open restoration margins of toothK0852Unrepairable overhanging of dental restorative materialsK08530Fractured dental restorative material without loss of materialK08531Fractured dental restorative material with loss of materialK08539Fractured dental restorative material, unspecifiedK0854Contour of existing restoration of tooth biologically incompatible with oral healthK0855Allergy to existing dental restorative materialK0856Poor aesthetic of existing restoration of toothK0859Other unsatisfactory restoration of toothK0881Primary occlusal traumaK0882Secondary occlusal traumaK0889Other specified disorders of teeth and supporting structuresK089Disorder of teeth and supporting structures, unspecifiedK090Developmental odontogenic cystsK091Developmental (nonodontogenic) cysts of oral regionK098Other cysts of oral region, not elsewhere classifiedK099Cyst of oral region, unspecifiedK120Recurrent oral aphthaeK121Other forms of stomatitisK122Cellulitis and abscess of mouthK1230Oral mucositis (ulcerative), unspecifiedK1231Oral mucositis (ulcerative) due to antineoplastic therapyK1232Oral mucositis (ulcerative) due to other drugsK1233Oral mucositis (ulcerative) due to radiationK1239Other oral mucositis (ulcerative)K130Diseases of lipsK131Cheek and lip bitingK1321Leukoplakia of oral mucosa, including tongueK1322Minimal keratinized residual ridge mucosaK1323Excessive keratinized residual ridge mucosaK1324Leukokeratosis nicotina palatiK1329Other disturbances of oral epithelium, including tongueK133Hairy leukoplakiaK134Granuloma and granuloma-like lesions of oral mucosaK135Oral submucous fibrosisK136Irritative hyperplasia of oral mucosaK1370Unspecified lesions of oral mucosaK1379Other lesions of oral mucosaK140GlossitisK141Geographic tongueK142Median rhomboid glossitisK143Hypertrophy of tongue papillaeK144Atrophy of tongue papillaeK145Plicated tongueK146GlossodyniaK148Other diseases of tongueK149Disease of tongue, unspecifiedM2600Unspecified anomaly of jaw sizeM2601Maxillary hyperplasiaM2602Maxillary hypoplasiaM2603Mandibular hyperplasiaM2604Mandibular hypoplasiaM2605MacrogeniaM2606MicrogeniaM2607Excessive tuberosity of jawM2609Other specified anomalies of jaw sizeM2610Unspecified anomaly of jaw-cranial base relationshipM2611Maxillary asymmetryM2612Other jaw asymmetryM2619Other specified anomalies of jaw-cranial base relationshipM2620Unspecified anomaly of dental arch relationshipM26211Malocclusion, Angle's class IM26212Malocclusion, Angle's class IIM26213Malocclusion, Angle's class IIIM26219Malocclusion, Angle's class, unspecifiedM26220Open anterior occlusal relationshipM26221Open posterior occlusal relationshipM2623Excessive horizontal overlapM2624Reverse articulationM2625Anomalies of interarch distanceM2629Other anomalies of dental arch relationshipM2630Unspecified anomaly of tooth position of fully erupted tooth or teethM2631Crowding of fully erupted teethM2632Excessive spacing of fully erupted teethM2633Horizontal displacement of fully erupted tooth or teethM2634Vertical displacement of fully erupted tooth or teethM2635Rotation of fully erupted tooth or teethM2636Insufficient interocclusal distance of fully erupted teeth (ridge)M2637Excessive interocclusal distance of fully erupted teethM2639Other anomalies of tooth position of fully erupted tooth or teethM264Malocclusion, unspecifiedM2650Dentofacial functional abnormalities, unspecifiedM2651Abnormal jaw closureM2652Limited mandibular range of motionM2653Deviation in opening and closing of the mandibleM2654Insufficient anterior guidanceM2655Centric occlusion maximum intercuspation discrepancyM2656Non-working side interferenceM2657Lack of posterior occlusal supportM2659Other dentofacial functional abnormalitiesM26601Right temporomandibular joint disorder, unspecifiedM26602Left temporomandibular joint disorder, unspecifiedM26603Bilateral temporomandibular joint disorder, unspecifiedM26609Unspecified temporomandibular joint disorder, unspecified sideM26611Adhesions and ankylosis of right temporomandibular jointM26612Adhesions and ankylosis of left temporomandibular jointM26613Adhesions and ankylosis of bilateral temporomandibular jointM26619Adhesions and ankylosis of temporomandibular joint, unspecified sideM26621Arthralgia of right temporomandibular jointM26622Arthralgia of left temporomandibular jointM26623Arthralgia of bilateral temporomandibular jointM26629Arthralgia of temporomandibular joint, unspecified sideM26631Articular disc disorder of right temporomandibular jointM26632Articular disc disorder of left temporomandibular jointM26633Articular disc disorder of bilateral temporomandibular jointM26639Articular disc disorder of temporomandibular joint, unspecified sideM26641Arthritis of right temporomandibular jointM26642Arthritis of left temporomandibular jointM26643Arthritis of bilateral temporomandibular jointM26649Arthritis of unspecified temporomandibular jointM26651Arthropathy of right temporomandibular jointM26652Arthropathy of left temporomandibular jointM26653Arthropathy of bilateral temporomandibular jointM26659Arthropathy of unspecified temporomandibular jointM2669Other specified disorders of temporomandibular jointM2670Unspecified alveolar anomalyM2671Alveolar maxillary hyperplasiaM2672Alveolar mandibular hyperplasiaM2673Alveolar maxillary hypoplasiaM2674Alveolar mandibular hypoplasiaM2679Other specified alveolar anomaliesM2681Anterior soft tissue impingementM2682Posterior soft tissue impingementM2689Other dentofacial anomaliesM269Dentofacial anomaly, unspecifiedM270Developmental disorders of jawsM271Giant cell granuloma, centralM272Inflammatory conditions of jawsM273Alveolitis of jawsM2740Unspecified cyst of jawM2749Other cysts of jawM2751Perforation of root canal space due to endodontic treatmentM2752Endodontic overfillM2753Endodontic underfillM2759Other periradicular pathology associated with previous endodontic treatmentM2761Osseointegration failure of dental implantM2762Post-osseointegration biological failure of dental implantM2763Post-osseointegration mechanical failure of dental implantM2769Other endosseous dental implant failureM278Other specified diseases of jawsM279Disease of jaws, unspecifiedQ184MacrostomiaQ185MicrostomiaQ186MacrocheiliaQ187MicrocheiliaQ351Cleft hard palateQ353Cleft soft palateQ355Cleft hard palate with cleft soft palateQ357Cleft uvulaQ359Cleft palate, unspecifiedQ360Cleft lip, bilateralQ361Cleft lip, medianQ369Cleft lip, unilateralQ370Cleft hard palate with bilateral cleft lipQ371Cleft hard palate with unilateral cleft lipQ372Cleft soft palate with bilateral cleft lipQ373Cleft soft palate with unilateral cleft lipQ374Cleft hard and soft palate with bilateral cleft lipQ375Cleft hard and soft palate with unilateral cleft lipQ378Unspecified cleft palate with bilateral cleft lipQ379Unspecified cleft palate with unilateral cleft lipQ380Congenital malformations of lips, not elsewhere classifiedQ381AnkyloglossiaQ382MacroglossiaQ383Other congenital malformations of tongueQ386Other congenital malformations of mouthR6884Jaw painS01501AUnspecified open wound of lip, initial encounterS01502AUnspecified open wound of oral cavity, initial encounterS01511ALaceration without foreign body of lip, initial encounterS01512ALaceration without foreign body of oral cavity, initial encounterS01521ALaceration with foreign body of lip, initial encounterS01522ALaceration with foreign body of oral cavity, initial encounterS01531APuncture wound without foreign body of lip, initial encounterS01532APuncture wound without foreign body of oral cavity, initial encounterS01541APuncture wound with foreign body of lip, initial encounterS01542APuncture wound with foreign body of oral cavity, initial encounterS01551AOpen bite of lip, initial encounterS01552AOpen bite of oral cavity, initial encounterS02400AMalar fracture, unspecified side, initial encounter for closed fractureS02400BMalar fracture, unspecified side, initial encounter for open fractureS02401AMaxillary fracture, unspecified side, initial encounter for closed fractureS02401BMaxillary fracture, unspecified side, initial encounter for open fractureS02402AZygomatic fracture, unspecified side, initial encounter for closed fractureS02402BZygomatic fracture, unspecified side, initial encounter for open fractureS0240AAMalar fracture, right side, initial encounter for closed fractureS0240ABMalar fracture, right side, initial encounter for open fractureS0240BAMalar fracture, left side, initial encounter for closed fractureS0240BBMalar fracture, left side, initial encounter for open fractureS0240CAMaxillary fracture, right side, initial encounter for closed fractureS0240CBMaxillary fracture, right side, initial encounter for open fractureS0240DAMaxillary fracture, left side, initial encounter for closed fractureS0240DBMaxillary fracture, left side, initial encounter for open fractureS0240EAZygomatic fracture, right side, initial encounter for closed fractureS0240EBZygomatic fracture, right side, initial encounter for open fractureS0240FAZygomatic fracture, left side, initial encounter for closed fractureS0240FBZygomatic fracture, left side, initial encounter for open fractureS02411ALeFort I fracture, initial encounter for closed fractureS02411BLeFort I fracture, initial encounter for open fractureS02412ALeFort II fracture, initial encounter for closed fractureS02412BLeFort II fracture, initial encounter for open fractureS02413ALeFort III fracture, initial encounter for closed fractureS02413BLeFort III fracture, initial encounter for open fractureS025XXAFracture of tooth (traumatic), initial encounter for closed fractureS025XXBFracture of tooth (traumatic), initial encounter for open fractureS02600AFracture of unspecified part of body of mandible, unspecified side, initial encounter for closed fractureS02600BFracture of unspecified part of body of mandible, unspecified side, initial encounter for open fractureS02601AFracture of unspecified part of body of right mandible, initial encounter for closed fractureS02601BFracture of unspecified part of body of right mandible, initial encounter for open fractureS02602AFracture of unspecified part of body of left mandible, initial encounter for closed fractureS02602BFracture of unspecified part of body of left mandible, initial encounter for open fractureS02609AFracture of mandible, unspecified, initial encounter for closed fractureS02609BFracture of mandible, unspecified, initial encounter for open fractureS02610AFracture of condylar process of mandible, unspecified side, initial encounter for closed fractureS02610BFracture of condylar process of mandible, unspecified side, initial encounter for open fractureS02611AFracture of condylar process of right mandible, initial encounter for closed fractureS02611BFracture of condylar process of right mandible, initial encounter for open fractureS02612AFracture of condylar process of left mandible, initial encounter for closed fractureS02612BFracture of condylar process of left mandible, initial encounter for open fractureS02620AFracture of subcondylar process of mandible, unspecified side, initial encounter for closed fractureS02620BFracture of subcondylar process of mandible, unspecified side, initial encounter for open fractureS02621AFracture of subcondylar process of right mandible, initial encounter for closed fractureS02621BFracture of subcondylar process of right mandible, initial encounter for open fractureS02622AFracture of subcondylar process of left mandible, initial encounter for closed fractureS02622BFracture of subcondylar process of left mandible, initial encounter for open fractureS02630AFracture of coronoid process of mandible, unspecified side, initial encounter for closed fractureS02630BFracture of coronoid process of mandible, unspecified side, initial encounter for open fractureS02631AFracture of coronoid process of right mandible, initial encounter for closed fractureS02631BFracture of coronoid process of right mandible, initial encounter for open fractureS02632AFracture of coronoid process of left mandible, initial encounter for closed fractureS02632BFracture of coronoid process of left mandible, initial encounter for open fractureS02640AFracture of ramus of mandible, unspecified side, initial encounter for closed fractureS02640BFracture of ramus of mandible, unspecified side, initial encounter for open fractureS02641AFracture of ramus of right mandible, initial encounter for closed fractureS02641BFracture of ramus of right mandible, initial encounter for open fractureS02642AFracture of ramus of left mandible, initial encounter for closed fractureS02642BFracture of ramus of left mandible, initial encounter for open fractureS02650AFracture of angle of mandible, unspecified side, initial encounter for closed fractureS02650BFracture of angle of mandible, unspecified side, initial encounter for open fractureS02651AFracture of angle of right mandible, initial encounter for closed fractureS02651BFracture of angle of right mandible, initial encounter for open fracture
ICD-10-CM/PCS MS-DRG v38.0 R1 Definitions Manual (2024)

FAQs

What does MS DRG stand for? ›

Medicare Severity Diagnosis Related Group (MS-DRG) Grouper Software and Medicare Code Editor (MCE) Version V40 MAINFRAME Software (ZIP) - Updated 11/03/2022: This is a replacement of the previously released Medicare Severity Diagnosis Related Groups v40.

What is a DRG diagnosis code? ›

Diagnosis Related Group (DRG) Codes

Diagnosis-related group (DRG) is a system which classifies hospital cases according to certain groups,also referred to as DRGs, which are expected to have similar hospital resource use (cost).

What is the MS DRG classification system? ›

The MS-DRG system assigns a unique code to each patient's hospital stay based on their principal diagnosis, secondary diagnoses, procedures performed, age, sex, and discharge status. These codes are used to classify patients into one of the 761 MS-DRG categories.

What is the difference between DRG and ICD-10? ›

DRGs are a classification system that groups patients with similar diagnoses and treatment patterns for billing and reimbursem*nt purposes. ICDs, on the other hand, are a system of codes used to classify and report diseases, injuries, and other health conditions for medical documentation and statistical analysis.

What is an example of a MS-DRG code? ›

Secondary diagnoses​- a specific set of secondary diagnoses are used in the definition of the MS-DRG. An example would be the presence of a secondary diagnosis of history of malignancy is used to define MS-DRG 082-084.

What is the most common DRG? ›

What are the most common DRGs? The most common DRG is septicemia, or sepsis, with more than 8% of diagnoses. Sepsis is also a top infectious disease. Heart failure is the second top DRG code, followed by respiratory infections and inflammations.

What does PCS stand for in medical coding? ›

The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed for the Centers for Medicare and Medicaid Services (CMS).

How to find MS DRG code? ›

You have a couple of options when it comes to identifying the code. You could look it up in the ICD-10-CM/PCS code book, you could contact the coding department and ask for help, or look it up using a search engine or app on your smart device.

What are the four types of DRGs? ›

Purpose
  • Medicare DRG (CMS-DRG & MS-DRG)
  • Refined DRGs (R-DRG)
  • All Patient DRGs (AP-DRG)
  • Severity DRGs (S-DRG)
  • All Patient, Severity-Adjusted DRGs (APS-DRG)
  • All Patient Refined DRGs (APR-DRG)
  • International-Refined DRGs (IR-DRG)

Who uses MS-DRG? ›

The DRG system covers acute care hospitals and critical access hospitals. The DRG pricing system uses the Centers for Medicare and Medicaid Services (CMS) DRG grouper developed for and used by Medicare, with enhancements for newborn DRGs and mental disease and disorder DRGs.

What is the purpose of a DRG? ›

A diagnosis-related group (DRG) is a case-mix complexity system implemented to categorize patients with similar clinical diagnoses in order to better control hospital costs and determine payor reimbursem*nt rates.

Is DRG inpatient or outpatient? ›

It's important to note that the DRG system only applies to inpatient hospital stays. Outpatient services are reimbursed differently. The DRG system was first introduced in 1982 as part of the Medicare Prospective Payment System (PPS).

How to calculate MS DRG payment? ›

To figure out how much money your hospital got paid for your hospitalization, multiply your DRG's relative weight by your hospital's base payment rate. Here's an example with a hospital that has a base payment rate of $6,000 when your DRG's relative weight is 1.3: $6,000 X 1.3 = $7,800.

What does the MS in front of the DRG mean? ›

The "MS" in front of the DRG typically stands for "Medical Severity." It indicates that the DRG classification takes into account the severity of the medical condition or the complexity of medical services required for a patient.

Who uses DRG codes? ›

DRGs are billing codes used by hospitals to help them determine how much and what to bill patients for.

What does DRG stand for in medical terms? ›

A diagnosis-related group (DRG) is a case-mix complexity system implemented to categorize patients with similar clinical diagnoses in order to better control hospital costs and determine payor reimbursem*nt rates.

What is the difference between MS-DRG and AP DRG? ›

AP-DRGs are similar to regular and MS-DRGs but also include a more detailed DRG breakdown for non-Medicare patients, particularly newborns and children.

What is the difference between a DRG and a CPT code? ›

ICD and CPT codes also play a more specific and defined role than DRGs. They are particular ways to code an individual diagnosis or procedure for many different kinds of care. DRGs, on the other hand, are overarching categories used to classify a part of a patient's care plan, which is more comprehensive.

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