diagnosis-related groups (DRGs)

Patient classification system that categorizes patients who are medically related with respect to principal diagnosis, presence of a surgical procedure, age, presence or absence of significant complications, treatment, and who are statistically similar in length of hospital stay. Medicare hospital insurance payments are based on fixed dollar amounts for a principal diagnosis as listed in DRGs regardless of the amount of charges accrued. See all patient diagnosis-related group (APDRG or AP-DRG) and inpatient prospective payment system (IPPS) .

Diagnostic

Medical service performed such as biopsy, thyroid function test, or radiographic procedure to establish the cause of the patient’s complaints and symptoms.

Diagnostic code

1. Numerical three-, four-, or five-digit code located in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code book and assigned to a patient’s medical condition, symptoms, or reason for the encounter as documented in the patient’s medical record. 2. Up to seven-digit code located in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) . The code is assigned to a patient’s medical condition, symptoms, or reason for the encounter that is documented in the patient’s medical record (see Figure D-1, A ). 3. When the physician’s office or an outpatient hospital is billing, the primary diagnosis code(s) is inserted in Block 21 of the CMS-1500 insurance claim form. For inpatient hospital billing, the principal diagnosis code is inserted in Field 66 and subsequent diagnosis codes in Fields 67 through 75 of the UB-04 insurance claim form. Diagnostic codes.