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  3. Diagnosis Codes in MS-DRG 193 - Simple Pneumonia And Pleurisy With MCC

Diagnosis Codes in MS-DRG 193 - Simple Pneumonia And Pleurisy With MCC

The Medicare Severity Diagnosis-Related Group (MS-DRG) is a patient classification system used to categorize hospital cases based on clinical similarity and expected resource use. MS-DRGs organize all possible principal diagnoses into mutually exclusive groups known as Major Diagnostic Categories (MDCs), which help determine reimbursement under the Medicare Inpatient Prospective Payment System.

This section lists the diagnosis codes included in MS-DRG V42.0: Simple Pneumonia and Pleurisy with MCC from October 1, 2024, through September 30, 2025.

MS-DRG: 193

MS-DRG Title: Simple Pneumonia and Pleurisy with MCC

MCD: 04

Relative Weight: 1.3178 Relative Weight
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Geometric LOS: 1.32 Geometric Length of Stay
The geometric mean length of stay (GMLOS) is used by Medicare to calculate the reimbursement for patients whose medical treatment takes a much longer or shorter time than average.

Arithmetic LOS: 4.00 Arithmetic Length of Stay
The average length of stay (ALOS) reflects the average number of days a patient spends in a hospital for each admission.

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    • J13 - Pneumonia due to Streptococcus pneumoniae

    • J14 - Pneumonia due to Hemophilus influenzae

  • B33 - Other viral diseases, not elsewhere classified

    • B33.0 - Epidemic myalgia

  • J09.X - Influenza due to identified novel influenza A virus

    • J09.X1 - Influenza due to identified novel influenza A virus with pneumonia

    • J09.X2 - Influenza due to identified novel influenza A virus with other respiratory manifestations

  • J10 - Influenza due to other identified influenza virus

    • J10.1 - Influenza due to other identified influenza virus with other respiratory manifestations

  • J10.0 - Influenza due to other identified influenza virus with pneumonia

    • 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

  • J11.0 - Influenza due to unidentified influenza virus with pneumonia

    • J11.00 - Influenza due to unidentified influenza virus with unspecified type of pneumonia

    • J11.08 - Influenza due to unidentified influenza virus with specified pneumonia

  • J12 - Viral pneumonia, not elsewhere classified

    • J12.0 - Adenoviral pneumonia

    • J12.1 - Respiratory syncytial virus pneumonia

    • J12.2 - Parainfluenza virus pneumonia

    • J12.3 - Human metapneumovirus pneumonia

    • J12.9 - Viral pneumonia, unspecified

  • J12.8 - Other viral pneumonia

    • J12.81 - Pneumonia due to SARS-associated coronavirus

    • J12.82 - Pneumonia due to coronavirus disease 2019

    • J12.89 - Other viral pneumonia

  • J15 - Bacterial pneumonia, not elsewhere classified

    • J15.3 - Pneumonia due to streptococcus, group B

    • J15.4 - Pneumonia due to other streptococci

    • J15.7 - Pneumonia due to Mycoplasma pneumoniae

    • J15.9 - Unspecified bacterial pneumonia

  • J16 - Pneumonia due to other infectious organisms, not elsewhere classified

    • J16.0 - Chlamydial pneumonia

    • J16.8 - Pneumonia due to other specified infectious organisms

  • J18 - Pneumonia, unspecified organism

    • J18.0 - Bronchopneumonia, unspecified organism

    • J18.1 - Lobar pneumonia, unspecified organism

    • J18.8 - Other pneumonia, unspecified organism

    • J18.9 - Pneumonia, unspecified organism

  • J92 - Pleural plaque

    • J92.0 - Pleural plaque with presence of asbestos

    • J92.9 - Pleural plaque without asbestos

  • J94 - Other pleural conditions

    • J94.1 - Fibrothorax

    • J94.9 - Pleural condition, unspecified

  • R09 - Other symptoms and signs involving the circulatory and respiratory system