DRG 056, 057: Degenerative Nervous System Disorders

Each of the Medicare Severity Diagnosis Related Groups (MS-DRG) is defined by a particular set of patient attributes which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. Major Complications or Comorbidity (MCC) and Complication or Comorbidity (CC) describe the severity of a secondary diagnosis in the inpatient prospective payment system (IPPS).

DRG 056 (Degenerative Nervous System Disorders with MCC) and DRG 057 (Degenerative Nervous System Disorders without MCC) is classified as a Medicare Diagnostic Category (MDC) 1 — Disease and Disorders of the Nervous System. The category is Neurology, and the Surgical Category is non-surgical. The ICD-10 MS-DRG Definitions Manual Files V40.1 (Effective April 1, 2023 through September 30, 2023), (ZIP), is available on the CMS website.

Many situations can cause a neuropathic condition. The most common medical condition to cause peripheral neuropathy is diabetes mellitus. The hyperglycemic state can cause direct injury to parts of the nerve cell, as well as indirect injury caused by lack of circulation (and subsequent nutrient deprivation) to the cells. Other medical conditions, such as HIV, kidney disorders, hormonal imbalances and cancers may also damage nerve cells. Heredity can play a role, as can traumatic situations such as a crush injury or fractured bone, which can result in compression, stretching, or severing of the nerve cell, leading to a neuropathic condition.

Below is the FY 2023 Final Rule Tables and Correction Notice Tables; Table 5 — List FY 2023 MS-DRGs, Relative Weighting Factors and Geometric Arithmetic Mean Length of Stay (ZIP) found on the CMS website.

Further Information

• The CMS Acute Inpatient PPS web page
• Federal Register: 2017-16434 (PDF)
• MS-DRG Classifications and Software | CMS
• Comprehensive Error Rate Testing (CERT): Part A Checklist (PDF)
• DRG 056: Degenerative Nervous System Disorders with MCC, DRG 057: Degenerative Nervous System Disorders without MCC Checklist (PDF)