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Diagnosis-Related Groups and Severity ICD-9-CM, the Real Problem

Robert L. Mullin, MD
JAMA. 1985;254(9):1208-1210. doi:10.1001/jama.1985.03360090098028.
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A GREAT deal has been written in the medical literature, the hospital industry literature, and the press about the insensitivity of the diagnosis-related groups (DRGs) to severity of illness.1 This statement has even come from the Congress of the United States.

Medisgrps Severity Classification  An article titled "Review System Based on Illness Severity" recently appeared in American Medical News.2 It describes the Medisgrps severity classification definitions. The article states: "At admission, Medisgrps assigns a patient to one of five severity groups, and then compares that severity with severity at a later date, typically 10 days after admission or six days after surgery." Since the average length of stay of Medicare patients is now under 8.8 days and non-Medicare patients under 5.6 days, a majority of the patients will be discharged before this second severity assignment. The table concerning DRG 122 appearing in the article is reproduced herein, with


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