To: In-state and Border Hospital Providers RE: InterQual and Adverse Events Policy and Billing Works 2025

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DRG 660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC.
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).
DRG 426 MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC.
These categories are identified using Diagnosis Related Group (DRG) codes each of which is assigned a relative weight appropriate for the relative amount of hospital resources used to treat the patient.
Medicare DRG (CMS-DRG MS-DRG) Refined DRGs (R-DRG) All Patient DRGs (AP-DRG) Severity DRGs (S-DRG)
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DRG 639 DIABETES WITHOUT CC/MCC. PRINCIPAL DIAGNOSIS.

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