Certified Inpatient Coding (CIC) Practice Exam

Which factor is never considered when determining a MS-DRG?

1. The principal procedure

2. The length of stay

3. The birth weight of a neonate

4. Secondary diagnoses

The correct answer is: The length of stay

The determination of a MS-DRG (Medicare Severity Diagnosis Related Group) is a classification system used to establish payment for inpatient hospital services. Each factor plays a distinct role in this classification, but not all factors influence MS-DRG assignment equally. Length of stay, while relevant to healthcare services and resource utilization, is not a direct factor in determining MS-DRG assignment. Instead, MS-DRGs are primarily calculated based on the clinical characteristics of the patient, the principal diagnosis, the principal procedure performed, and any relevant secondary diagnoses. The focus is on the specific diagnoses and complications rather than the duration of the hospital stay. In contrast, factors like the principal procedure (which directly correlates with the treatment performed), the birth weight of a neonate (important for categorizing neonatal cases), and secondary diagnoses (which can influence the severity and complexity of a case) are all critical to accurately assigning the appropriate MS-DRG. Thus, the length of stay is an outlier that, while informative for operational aspects, does not directly affect the MS-DRG classification process.