MS-DRG 195 – Simple Pneumonia and Pleurisy without CC/MCC
A Medical DRG in MDC 04 (Diseases & Disorders of the Respiratory System). Inpatient cases group to DRG 195 when the ICD-10-CM principal diagnosis is one of the 34 codes listed below and no secondary diagnosis on the CC or MCC lists is present. Its FY 2026 relative weight is 0.6285 with a geometric mean length of stay of 2.2 days.
Severity family
The grouper first assigns the case to MDC 04 from the principal diagnosis and finds no qualifying operating-room procedure (this is a Medical DRG; ICD-10-PCS codes do not drive assignment here), then applies the severity split from secondary diagnoses: with MCC → 193; with CC → 194; without CC/MCC → 195.
Principal Diagnosis Codes 34 codes · 13 categories
B33 Other viral diseases, not elsewhere classified1 code
- B33.0 Epidemic myalgia
J09 Influenza due to certain identified influenza viruses2 codes
J10 Influenza due to other identified influenza virus4 codes
- J10.00 Influenza due to other identified influenza virus with unspecified type of pneumonia
- J10.01 Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
- J10.08 Influenza due to other identified influenza virus with other specified pneumonia
- J10.1 Influenza due to other identified influenza virus with other respiratory manifestations
J11 Influenza due to unidentified influenza virus2 codes
J12 Viral pneumonia, not elsewhere classified8 codes
- J12.0 Adenoviral pneumonia
- J12.1 Respiratory syncytial virus pneumonia
- J12.2 Parainfluenza virus pneumonia
- J12.3 Human metapneumovirus pneumonia
- J12.81 Pneumonia due to SARS-associated coronavirus
- J12.82 Pneumonia due to coronavirus disease 2019
- J12.89 Other viral pneumonia
- J12.9 Viral pneumonia, unspecified
J13 Pneumonia due to Streptococcus pneumoniae1 code
- J13 Pneumonia due to Streptococcus pneumoniae
J14 Pneumonia due to Hemophilus influenzae1 code
- J14 Pneumonia due to Hemophilus influenzae
J15 Bacterial pneumonia, not elsewhere classified4 codes
J16 Pneumonia due to other infectious organisms, not elsewhere classified2 codes
J18 Pneumonia, unspecified organism4 codes
J92 Pleural plaque2 codes
R09 Other symptoms and signs involving the circulatory and respiratory system1 code
- R09.1 Pleurisy
Procedure Codes
Frequently Asked Questions
What is MS-DRG 195?
MS-DRG 195 (Simple Pneumonia and Pleurisy without CC/MCC) is a medical DRG in MDC 04 (Diseases & Disorders of the Respiratory System). Its FY 2026 relative weight is 0.6285 with a geometric mean length of stay of 2.2 days.
What is the difference between DRG 193, 194, 195?
All 3 share the same base category; the severity of secondary diagnoses separates them: 193 (with MCC), 194 (with CC), 195 (without CC/MCC). A major complication or comorbidity (MCC) places the case in the highest-weighted DRG of the family; a CC in the middle; neither in the lowest.
How many diagnosis codes group to DRG 195?
34 ICD-10-CM principal diagnosis codes group to this DRG, spanning 13 three-character categories.
What is the relative weight of DRG 195?
The FY 2026 relative weight of this DRG is 0.6285, meaning reimbursement of roughly 0.63 times the average Medicare inpatient case. Multiply by a hospital's blended base rate for the approximate payment.
