A secondary condition is clinically integral to the principal diagnosis and appears on a CMS exclusion pair for that principal. What is the expected MS-DRG effect?
Select an answer to reveal the explanation.
Short Explanation
If a finding is basically baked into the principal diagnosis—or CMS excludes that pair—you do not get a free CC bump from restating it. Severity lists have exclusion logic for a reason.
Full Explanation
MS-DRG CC/MCC methodology excludes certain secondary diagnoses when they are integral to or excluded with a given principal diagnosis. In those cases the secondary does not independently elevate the CC/MCC tier. This inpatient grouping concept is distinct from outpatient APC logic and does not create a second principal diagnosis.