Certified Inpatient Coding (CIC) Practice Exam

Which type of DRG system uses degrees of Severity of Illness and Risk of Mortality to determine the DRG?

1. AP-DRG

2. MS-DRG

3. APR-DRG

4. CMS-DRG

The correct answer is: APR-DRG

The correct choice for identifying the type of DRG system that uses degrees of Severity of Illness and Risk of Mortality to determine the DRG is the APR-DRG, which stands for All Patient Refined Diagnosis Related Group. This coding system provides a more granular classification by incorporating measures of severity and risk, allowing for a more comprehensive assessment of patient care and resource use. APR-DRGs refine the original DRG system by adding subclasses based on severity of illness (which reflects how sick a patient is) and risk of mortality (which assesses the likelihood of patient death). This classification helps to better account for the complexities and variations in patient conditions, ultimately supporting hospitals in adjusting for patient risk in their reimbursement rates and benchmarking. In contrast, other DRG systems such as AP-DRG and MS-DRG do not use this specific two-dimensional approach of severity of illness and risk of mortality in the same way. The AP-DRG system primarily groups patients based on diagnoses without this additional granularity, while MS-DRGs, used primarily by Medicare, focus on significant diagnosis but do not include the degrees of severity and risk that APR-DRGs uniquely account for. CMS-DRG refers to the DRG system used by the