MS-DRG 195: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
MS-DRG 195 is simple pneumonia and pleurisy without cc/mcc, in MDC 04 (a medical DRG), at the without-CC/MCC level. Its FY2027 relative weight is 0.6063, so a case here pays less than the average Medicare inpatient stay (weight 1.0), with a geometric mean length of stay of 2.20 days. 34 ICD-10-CM principal diagnoses group into MS-DRGs 193–195 under the CMS definitions manual; the most-searched are listed below.
FY2027 payment factors
- Relative weight
- 0.6063
- Geometric mean LOS
- 2.20
- Arithmetic mean LOS
- 2.60
- Post-acute transfer
- Yes
This DRG is subject to the post-acute care transfer policy: a discharge to a qualifying setting below the mean length of stay is paid per diem rather than in full.
Principal diagnoses that group to MS-DRGs 193–195
From the CMS MS-DRG definitions manual’s principal-diagnosis index: 34 ICD-10-CM codes route here, and the CC/MCC status of the secondary diagnoses decides which of 193–195 the case lands in. The 24 most-searched:
- J18.9Pneumonia, unspecified organism
- J10.1Influenza due to other identified influenza virus with other respiratory manifestations
- J15.9Unspecified bacterial pneumonia
- J18.8Other pneumonia, unspecified organism
- J12.82Pneumonia due to coronavirus disease 2019
- J13Pneumonia due to Streptococcus pneumoniae
- J18.1Lobar pneumonia, unspecified organism
- J09.X2Influenza due to identified novel influenza A virus with other respiratory manifestations
- J10.00Influenza due to other identified influenza virus with unspecified type of pneumonia
- J11.00Influenza due to unidentified influenza virus with unspecified type of pneumonia
- J12.1Respiratory syncytial virus pneumonia
- J12.9Viral pneumonia, unspecified
- J16.8Pneumonia due to other specified infectious organisms
- J18.0Bronchopneumonia, unspecified organism
- R09.1Pleurisy
- B33.0Epidemic myalgia
- J09.X1Influenza due to identified novel influenza A virus with pneumonia
- J10.01Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
- J10.08Influenza due to other identified influenza virus with other specified pneumonia
- J12.0Adenoviral pneumonia
- J12.3Human metapneumovirus pneumonia
- J12.81Pneumonia due to SARS-associated coronavirus
- J12.89Other viral pneumonia
- J14Pneumonia due to Hemophilus influenzae
10 more codes group here. Open any code above for its full hierarchy, or check a whole claim in the free DRG calculator.
The severity splits
Same base DRG, split by whether a secondary diagnosis is a CC or MCC. The last column is the weight change from MS-DRG 195.
| 193 | SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 1.2825 | +0.6762 |
| 194 | SIMPLE PNEUMONIA AND PLEURISY WITH CC | 0.7888 | +0.1825 |
| 195 | SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC | 0.6063 |
Choosing the principal diagnosis: Pneumonia ICD-10 codes, Influenza ICD-10 codes.
All FY2027 MS-DRGs · MDC 04