drgpy

drgpy is a Python library for assigning a combination of diagnosis and procedure codes to Diagnosis Related Groups (MS-DRG) that is used in Medicare inpatient reimbursement today.

NOTE the current default version is configured as MSDRG v40. However, the latest version is not thoroughly tested yet. Please use at your own risk. Rawfiles: https://www.cms.gov/files/zip/icd-10-ms-drg-definitions-manual-files-v372.zip

Installing

Installing from the source:

$ git clone git@github.com:yubin-park/drgpy.git
$ cd drgpy
$ python setup.py develop

Or, simply using pip:

$ pip install drgpy

File Structure

• drgpy/: The package source code is located here.
  • data/: The raw data files downloaded from the CMS website.
  • msdrg.py: The main file for the MS-DRG logic.
  • _mdcsrdr.py: A script that reads/parses mdcs_xx_xx.txt data files.
  • _appndxrdr.py: A script that reads/parses appendix_xx.txt data files.
  • _mdcs0007.py: logics for MDC00 - MDC07
  • _mdcs0811.py: logics for MDC08 - MDC11
  • _mdcs1221.py: logics for MDC12 - MDC21
  • _mdcs2225.py: logics for MDC22 - MDC25
• tests/: test scripts to check the validity of the outputs.
• LICENSE.txt: Apache 2.0.
• README.md: This README file.
• setup.py: a set-up script.

Code Examples

drgpy is really simple to use. Please see some examples below. NOTE that all functions used below have docstrings. If you want to see the input parameter specifications, please type print(<instance>.<function>.__doc__).

A Wrapper Model for All Versions

To use a wrapper model for all versions from 36 to 40, please use as follows:

>>> from drgpy.msdrg_allvers import DRGEngineAllVers
>>> de = DRGEngineAllVers()
>>> print(de.get_drg.__doc__)

        Return the corresponding DRG code for the diagnoses and procedures

        Parameters
        ----------
        dx_lst : list
                A list of ICD-10 diagnosis codes
        pr_lst : list
                A list of ICD-10 procedure codes
        date: str
                YYYY-MM-DD format
                Depending on the date of the claim,
                the engine will choose the appropriate version.
                e.g. date between 2020-10-01 will use v39...
        gender: str
                "F" or "M"
        is_alive: boolean
                if the patient is alive at discharge (True)

Each Version Separately

NOTE that this usage doesn't require the date field.

>>> from drgpy.msdrg import DRGEngine
>>> de = DRGEngine(version="v40")
>>> print(de.get_drg.__doc__)

        Return the corresponding DRG code for the diagnoses and procedures

        Parameters
        ----------
        dx_lst : list
                A list of ICD-10 diagnosis codes
        pr_lst : list
                A list of ICD-10 procedure codes
        gender: str
                "F" or "M"
        is_alive: boolean
                if the patient is alive at discharge (True)
>>>
>>> de.get_drg(["B20"],[])
'977'
>>> de.get_drg([], ["02HA0RS"])
'983'
>>> de.get_drg([], ["02HA0RS", "02PA0RZ"])
'002'
>>>

Please refer to the test scripts under the tests/ folder if you want to see other example use cases.

Raw Data Change Log

1. For v38+, in mdcs_00_07.txt, edit

NON-OPERATING ROOM PROCEDURES
02H63JZ*

to

NON-OPERATING ROOM PROCEDURES

  02H63JZ*

2. For any version, in mdcs_08_11.txt, remove

To qualify as bilateral or multiple joint procedures you must have at least one code from two different lower extremity sites as listed below.
Examples: left hip  and right hip - bilateral; left hip and left knee - multiple;  left hip and right ankle - multiple; left knee and right knee - bilateral

3. In mdcs_00_07.txt, remove

COMBINATION OF CODES IN THE NEXT FOUR LISTS
...

Alos, in v40, duplicate sections exist for this part.

4. In mdcs_12_21.txt, remove

Principal or secondary diagnosis of newborn or neonate,with other significant problems, not assigned to DRG 789 through 793 or 795

5. In mdcs_12_21.txt, for v38+ DRG 768 and 798, edit

NON-OPERATING ROOM PROCEDURES
10D07Z3* Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening

to

NON-OPERATING ROOM PROCEDURES

  10D07Z3* Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening

6. In mdcs_12_21.txt, for DRG 807,

NON-OPERATING ROOM PROCEDURES
10D07Z3*

to

NON-OPERATING ROOM PROCEDURES

  10D07Z3*

7. For v36, in appendix_D_E.txt,

Removed 10D17Z9 14 768 10D18Z9 14 796

As the DRG definition say other OR procedures except for these two above, but these are included as OR procedures in the appendix. Rather than changing the algorithm to deal with the discrepancy, we edit the underlying data to maintain consistency.

8. Any versions, in mdcs_08_11.txt,

There are group-level or conditions for 456&457&458, e.g., one of... "and" with one of...

Their categories are renamed as EXTENSIVE FUSION PART AB12..

License

Apache 2.0

Authors

Yubin Park, PhD

References

• https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html
• https://www.cms.gov/files/zip/icd-10-ms-drg-definitions-manual-files-v372.zip
• https://content.findacode.com/files/tutorials/DRG-Grouper-2019.pdf