drg assignment list

Assignments

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Assignment Board Terminal

Assignment Selection

Assignments are short quests, consisting of a series of missions . You can have one active assignment at a time, and choose it at the Assignment Board in the Space Rig .

There are currently 35 assignments available: Conquering Hoxxes IV , Four Promotion Assignments , Seven Prestige , Sixteen Weapon License Assignments , One assignment for unlocking Hazard 5 difficulty, One assignment for unlocking the Mineral Trade Terminal , One assignment for unlocking Industrial Sabotage , Heavy Duty and Weekly Assignments . Additionally the Weekly Core Hunt reward Infused Matrix Core after completing Breach The Core .

• 1.1 Objective: Conquer Hoxxes IV
• 1.2 Company Benefits: Mineral Trading Network
• 1.3 Objective: Breach The Core
• 1.4 New Hazard Level: Lethal
• 1.5 Spec Ops: Sabotage Training
• 1.6 Warning: Rival Escalation
• 1.7.1 Weekly Priority Assignment
• 1.7.2 Weekly Core Hunt
• 1.8.1 Driller
• 1.8.2 Engineer
• 1.8.3 Gunner
• 1.8.4 Scout
• 1.9.1 Driller
• 1.9.2 Engineer
• 1.9.3 Gunner
• 1.9.4 Scout
• 1.10.1 Heavy Duty
• 1.10.2 Pickaxe Hunts
• 1.10.3 Armor Hunts
• 1.11.1 Lunar Convergence Cleanup
• 1.11.2 Anniversary Bonus
• 1.11.3 The Great Egg Hunt
• 1.11.4 Hoxxes Summer Cruise
• 1.11.5 Oktoberfest Celebration
• 1.11.6 Halloween Party Special
• 1.11.7 The Horrors of Hoxxes
• 1.11.8 Yearly Performance Bonus

Assignments [ ]

Objective: conquer hoxxes iv [ ].

This is a 10-mission long assignment that has to be played by every new player to unlock all available mission types and Planetary Regions . These missions are free of Mutators .

Company Benefits: Mineral Trading Network [ ]

This is a short, 3 mission long assignment that will unlock the Mineral Trade Terminal It becomes available after Conquering Hoxxes IV assignment has been completed.

Objective: Breach The Core [ ]

Upon obtaining the first promotion , the end campaign assignment mission is unlocked. Completing this 9 mission long assignment will reward the player with 6 Infused Matrix Cores, as well as unlocks the Weekly Core Hunt assignment.

New Hazard Level: Lethal [ ]

This is a 3 mission-long assignment, upon completion the player is granted access to Hazard 5 - Lethal. The assignment's missions can have mutators and have to be completed at Hazard 4.

Spec Ops: Sabotage Training [ ]

A 3 mission long assignment that will grant the player access to the mission type Industrial Sabotage upon completion.

Warning: Rival Escalation [ ]

1 Rewards a Blank Matrix Core if all Weapon Overclocks are owned 2 Rewards a Mineral Canister if all Matrix Core Cosmetics are owned

Note that this assignment is unusual, as it can provide Blank Matrix Cores before a player has promoted their first miner and unlocked The Forge and Machine Events . Because Machine Events cannot be initiated pre-promotion, the only way to preemptively use these cores is to find a Machine Event while playing with another player who has already acquired the Tritilyte Key.

Weekly Assignments [ ]

These two assignments are repeatable in order to reward players for continued play. Like Deep Dives , they reset at 11am UTC on Thursdays.

Weekly Priority Assignment [ ]

Weekly Core Hunt [ ]

Equipment Licenses [ ]

Dwarves will unlock these assignments once reaching specific levels, these assignments grant them licenses to various equipment.

Driller [ ]

Engineer [ ], promotion [ ].

When one of your dwarves reaches Character Level 25, they become eligible for a promotion . In order to promote, you have to complete a 4-mission long assignment, and pay a large amount of Credits and Crafting Materials.

Prestige Assignments [ ]

Heavy Duty [ ]

This assignment becomes available after Conquering Hoxxes IV assignment has been completed. It's focused on the big machinery Missions and will reward 50 of each crafting materials, credits and a special helmet.

Pickaxe Hunts [ ]

Armor hunts [ ], special events [ ], lunar convergence cleanup [ ].

Assignment temporally available during the Hoxxes Lunar Festival event in January.

Anniversary Bonus [ ]

Assignment temporally available during the Anniversary Bonus event in February.

The Great Egg Hunt [ ]

Assignment temporally available during the Easter event in April.

Hoxxes Summer Cruise [ ]

Assignment temporally available during the Space Beach Party event in June.

Oktoberfest Celebration [ ]

Assignment temporally available during the Oktoberfest event in September.

Halloween Party Special [ ]

Assignment temporally available during the Halloween Season event in October.

The Horrors of Hoxxes [ ]

Yearly performance bonus [ ].

Assignment temporally available during the Holiday Season event at the end of the year.

• 1 Promotion
• 2 Equipment
• 3 Abyss Bar

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Season 04: critical corruption.

Overview DRG Updates Season 04

Season 04: Critical Corruption was first teased with a series of teasers on Ghost Ship Games' Youtube account , of which the first released on the 19th April 2023. They were shown during live streams through 2 months, most of the time in the later segment. In one of the patch notes before the image reveal, one of the changes listed that the season countdown timer would be accurate to the release date, and the season would roll out on time. A partially obscured an edited image teasing Season 4 was shown in a later stream, and fully revealed soon after.

Season 4 was released on June 15th, 2023 (PC) and June 22nd, 2023 (Console).

Narrated Update Trailer:

• 1.1 Season Event: Rockpox Corruptor
• 1.2.1 Rockpox Breeder
• 1.2.2 Rockpox Bomber
• 1.2.3 Rockpox Spitter
• 1.2.4 Rockpox Exploder
• 1.3.1 Glyphid Stingtail
• 1.3.2 Glyphid Septic Spreader
• 1.4 Jet Boots
• 1.5 Space Rig Addition: Jetty Boot
• 1.6 New Beer: Randoweisser
• 1.7 Equipment Terminal: Randomize Loadouts
• 1.8 Community Request: Copy/Paste Loadouts
• 1.9 Wardrobe: Sleeveless Armors
• 1.10 Weapon Input Buffer
• 1.11 Weapon Balance
• 1.12 Miscellaneous
• 3.1 Patch 1
• 3.2 Patch 2
• 3.3 Patch 3
• 3.4 Patch 4
• 3.5 Patch 5
• 3.6 Patch 6
• 3.7 Patch 7
• 3.8 Patch 8
• 3.9 Patch 9
• 3.10.1 Toggle option for seasonal content
• 3.10.2 Weapon Maintenance reward system
• 3.10.3 Reductions of Rockpox effects
• 3.10.4 Tweaks to enemy stats / behavior
• 3.10.5 Weapon tweaks
• 3.10.6 Miscellaneous
• 3.10.7 Media
• 3.11 Patch 11
• 3.12 Patch 12
• 3.13 Patch 13
• 3.14.1 Introducing Hidden Dwarf beer
• 3.14.2 Weapon tweaks and fixes
• 3.14.3 Armor and 'Armor Breaking' modifications
• 3.14.4 General bug fixes
• 3.14.5 QoL features
• 3.14.6 Media
• 3.15 Patch 15

Update Changes

Season event: rockpox corruptor.

The Plague Hearts you have encountered previously have evolved. They will now turn into Lithophage Corruptors-ravenous, fully mobile abominations that spread Rockpox wherever they go. They appear impervious to normal gunfire, so you will need to use the Cleansing Equipment to get through their exterior shells and expose their soft, inner core.

New Rockpox Enemies

Rockpox breeder.

A result of increased Rockpox infection of airborne fauna. The infection has changed the internal workings of its host to allow for Rockpox Larvae to sprout and thrive within its body.

Rockpox Bomber

As if the Goo Bomber wasn't bad enough already: The lithophage has spread to the volatile excretion this critter is so loved for, expanding the reach of the disease at a high rate.

Rockpox Spitter

The Rockpox Acid Spitter has turned its already impressive bio-projectiles into a highly infectious Rockpox vector, and with a suppressed pain response and high dose of combat pheromones the Rockpox Spitter poses a far greater threat than before!

Rockpox Exploder

The Rockpox Exploder has had profound mutations to its body, thickening its skin and reducing its volatility in turn of being filled to the brim with highly contagious Lithophage spores. Being caught in the blast zone will instantly infect any dwarves nearby, so stay clear of them at all costs!

New Enemies

Glyphid stingtail.

A powerful, heavily armored beast with a grasping tail, capable of pulling in any enemy and goring them against its massive horns. Take care around this one!

Glyphid Septic Spreader

The malicious cousin of our old friend, the Glyphid Spitter. This one fires heavy globules of rancid biomatter, which spread out in a wide area around impact. Mind your step and try to ignore the smell!

You will now be able to recover crates of high powered jet modules in the caves. Attach these to your boots and turn them into fully functional jet boots, giving you a much- needed leg-up during any hardships you may encounter!

Space Rig Addition: Jetty Boot

Back home, a bit of redundant machinery has been cleared out, opening up the Space Rig a bit more- which handily allows plenty of space to install a training terminal for the coded locks you will encounter on the Jet Boot crates. It would appear some smart- aleck has even seen fit to build an arcade cabinet to fit it into. Bring lots of credits!

New Beer: Randoweisser

This potent ale reportedly instills a sense of adventure and lust for challenge in whoever drinks it, randomizing all equipment, perks and cosmetics for the duration of a mission. Drink it at your own leisure!

Equipment Terminal: Randomize Loadouts

At the Loadout Terminal, a new option to randomize all your gear and upgrades has also become available, enabling you to quickly set up challenges for yourself. Why would anyone do this? Well, never let it be said we do not wish to enable our employees!

Community Request: Copy/Paste Loadouts

Additionally, you can now copy and paste loadouts for a smoother experience when experimenting with new weapon and mod combinations, without the hassle of redoing everything from scratch!

Wardrobe: Sleeveless Armors

Some of your armors now come with a new option: Toggle between sleeveless versions of most of your owned sets! This does not count for DLC Armors or armors that are already sleeveless.

Weapon Input Buffer

Thanks to the hard work of the folks at R&D, all semi-automatic weapons now come with fancy input buffering. This will make it easier to consistently maintain a high rate of fire, especially on weapons like the Subata, M1000 and EPC.

Weapon Balance

• The Subata has long been in need of an update. As always if you unlocked any of the removed upgrades their cost will be refunded.
• Increased base weakpoint damage bonus (from 1.2 to 1.25)
• Reduced base ammo (from 160 to 144)

Modification Tweaks

• Reduced the bonus of the T1 High Capacity Magazine upgrade
• Moved the T1 Reload Speed upgrade to T3
• Increased the bonus of the T2 Ammo upgrade
• Increased the bonus of the T2 Damage upgrade
• Removed the T3 Damage upgrade
• Added a new 2-Round Burst upgrade on T3
• Moved the T3 Ammo upgrade to T4 and increased it's bonus
• Increased the bonus of the T4 Hollow-Point Bullets upgrade
• Removed T5 Acid Coated Bullets upgrade
• Added the Neuro-Corrosive Catalyst upgrade to T5
• Added a Blowthrough Rounds upgrade to T5

Tranquilizer Rounds OC

• Added a "slow" effect to help with enemies that are immune to stun
• Changed the rate of fire penalty from a flat value to a percentage

M1000 Classic Hipster OC

• Reduced the RoF bonus to compensate for the RoF boost from the input buffer.

Jury-Rigged Boomstick Double Barrel OC

• Replaced the small pellet damage bonus with a large bonus to Blast Wave damage
• Added a shot spread penalty
• Made both shots fire simultaneously and updated the weapon stats and ammo display to clarify this
• Changed OC type from Clean to Unstable

Breach Cutter Spinning Death OC

• Reduced the ammo penalty

Cryo Cannon Snowball OC

• Reduced ammo cost
• Affected targets cannot warm-up for a short time after getting hit

DRAK-25 Plasma Carbine Shield Battery Booster OC

• Removed overheat recovery time penalty
• Added a significant shield regeneration bonus

"Hurricane" Guided Rocket System

• Replaced the clean Manual Guidance Cutoff OC with the new unstable Rocket Barrage OC

Plasma Burster Missiles OC

• Guidance system update prevents missiles from hitting the ground while swarming around a target
• Increased the number of hits a single missile can deliver before expiring

"Thunderhead" Heavy Autocannon Carpet Bomber OC

• Changed the explosion radius bonus from a flat to a percentage to significantly expand it when taken together with the AoE Range upgrade
• Changed the damage bonus from a flat to a percentage for an increased maximum when taken together with the AoE Damage upgrade

Neurotoxin Payload OC

• Reduced the AoE size bonus
• Added an ammo penalty
• Removed the direct damage penalty
• Increased the AoE damage penalty slightly

Miscellaneous

• Fixed E priorities to prioritize reviving a down dwarf over shield boosting him
• Fixed an issue where the dwarf would talk about getting more canisters when inserting the 2nd fuel canister in the Drilldozer
• Made Patrolbots stand still while you hack them
• Centered a Rockbox particle that was unaligned in a M.U.L.E on the Spacerig
• Made it so Exploders only explode once in missions with Volatile Guts, instead of twice
• Fixed a bug with changing languages that made it so not everything changed when it should change
• Fixed the wrong mission control progress shouts playing during the Lithophage Meteorite event.
• Fixed a bug that caused scouts flare gun to not damage small enemies such as shredders, maggots and rockpox blisters
• Fixed a bug that caused Breeders to become invisible when frozen
• Fixed a bug that caused cave leeches to sometimes be silent for clients
• Fixed a bug that caused leeches to not look frozen when frozen
• Put the red light on the leeches back where it should be (not floating like a weird orb outside its mouth)
• Mactera corpses now dissolve like other enemies instead of just popping out of existence
• Fixed a terrain bug that caused swarmer hole debris to show up in rooms without any actual swarmer holes.
• Tweaked the terrain generation around the caretaker to improve variety and allow biomes and cave generation to have a greater impact on the area
• Made it so Rock Cracker pods can’t land inside each other
• Fixed that drop pod would sometimes land inside the walls
• Fixed that the grappling hook would sometimes cancel its shot and have to recharge when you shoot and sprint or land while sprinting.
• Fixed a bug that caused rejoining clients to not be able to see the blast sphere on previously active and still active C4
• Removed the little IFG label from the IFG that could be seen by other players but not the person throwing it
• Fixed a bug that caused the Nishanka Boltshark X-80 Broadhead bolts to not apply the correct amount of radial damage
• Fixed a crash caused by host getting grabbed while holding a grenade
• Fixed a bug that caused sounds to loop when triggering ‘Today's special’ beer effect
• Fixed a bug that caused the ‘Show network stats’ option to reset
• Fixed some incorrect visual stats for the Warthog Auto 210: Magnetic Pellet Alignment OC
• Fixed a small skinning issue with the mk5 armor
• Fixed a skinning issue with the Waster weapon framework
• Fixed a bunch of typos
• Bosco now makes a sound, and has improved visuals when vacuuming
• Rockpox waves now have a small chance to spawn during normal missions
• Increased the difficulty for spawned enemies near plague towers and during cleaning
• Everyone can now be dead for 0.5 seconds longer before a mission fails
• Mission control should no longer mention sending down drop pods on salvage missions
• Sabotage missions can now have mutators - like they were supposed to
• The core infuser now carves the terrain around it when you complete the machine event
• The LithoVac and the LithoFoam now have a shiny hologram above them when dropped
• Thrown objects will now carry some of the player's momentum
• Changed the cleaning pod placement, now they can only be placed on terrain
• Added some extra breach effects to Heartstone after the final break
• Fixed Flying rocks appearing in phase 3 of the Heartstone fight
• Improved streamer mode, and made ambient space rig music controlled by each client instead of the host
• Barrels that do not go through the Hoop now explode instead of just popping out of existence
• Added game version and mission seed numbers to cave HUD
• Loadout UI in the escape menu now also shows armor and pickaxe modifications
• Fixed an issue where the pop-up for Color Vision Deficiency options in the options menu would appear beneath other option UI bits
• Fixed a bug that caused perk tooltips to sometimes not show in the equipment terminal
• Updated the credit list to include new community translators
• Changed driller monochrome armor paint job to yellow tones instead of blue
• Changed the ordering of DLCs in the DLC menu. Now newest is first on the list.
• Optimized the drop pod dice
• Improved shadows on the space rig
• Optimised weapons and devices when not in use
• Added more newsticker messages on the trade terminal
• Added a new fire sound for the Subata 120 when using the 2-round burst modification
• Changed Armskore Coil Gun OC Hellfire description to make it reflect the fact that it increases charge time, not reduces it
• Fixed the Boomstick T2 Rate of Fire upgrade also reducing the reload speed
• Hexawing now dies instantly when frozen.
• Fixed goo cannon only consuming 1 ammo every other full charged shots if done consecutively
• Fix for bug where breaking one armor plate on some enemies, would make some other armor plate unbreakable
• Fixed enemy armor sometimes still being breakable when it shouldn't be (ex. when frozen)
• Made the praetorian(normal, ice, rockpox) spit particles better match the attack hitbox
• Fixed Thermal exhaust feedback overclock for plasma carbine not staging damage upgrades correctly

The unobscured image, showing the release dates of June 15 on PC and June 22 on Console.

Post Update Hotfixes

June 20th, 2023

• Added sound to randomize buttons
• Flaregun flares will now fall to the ground when hitting the corrupter
• Fixed usable bar sticking around after someone cancels reviving you
• Menace and acid spitter now plays their stun animation
• Septic spreader now plays strafe and stun animations correctly
• Septic spreader now checks line of sight from its center
• Fixed client side butt animation issue for the Septic Spreader
• The septic spreader can no longer shoot behind itself
• Septic spreader added attack tell scream+misc attenuation tweaks
• Fixed crash related to foaming the Corruptor
• Reverted some changes to wave manager that was causing problems
• Adjusted engineer cable color on the DLC09 paintjob to red
• Stingtail now only does its sting attack if its within 10m vertical distance of its target
• Updated the icons of the Healthy armor upgrade so that they are not the same as the Shield upgrade
• Corruptor no longer despawns if you move too far away from it
• Fixed a bug that caused copying loadout changes loadout of other classes
• Fixed Randoweisser picks from already existing player's loadouts
• Fixed that Bet-C was targeting untargetable enemies
• Steeve now has a white outline when pinged instead of the usual red
• Fixed wave cooker not working for the remainder of a mission if you canceled firing right as you start firing it

DRAK-25 (Thermal Exhaust Feedback OC)

• Increased the damage and heat bonus to compensate for the now properly working scaling
• Fixed a bug that caused stingtails to sometimes pull players out of bounds
• Fixed crash related to shot impact sound
• Fixed issue that caused all building progress to reset when the player stopped building

June 26th, 2023

• Fixed Incorrect mission control voiceline on salvage with lithophage warning
• Fixed Driller Platinum paintjob inconsistent with other classes
• Fixed Sandshark teleporting to mission start when it turns vulnerable
• Fixed Septic Spreader not having arched line of sight checks
• Fixed cases where double boss healthbar could appear
• Fixed pickaxe copy/paste changed weapon loadout
• Fixed issue with small beard and armours
• Fixed mission control repeating the progress shouts for the meteor multiple times
• Fixed Incorrect displaying rate of fire of minigun
• Fixed subata explosive rounds only working on caretaker vents when more than one of them were alive
• Randoweisser will now correctly randomize pickaxe again

June 28th, 2023

• Fixed an issue that would make the lobber walk up to the player and boop them without trying to shoot at them
• Attempt at fixing Randoweisser beer has problem with certain Overclocks
• Fixed Players can pick up two beers at once from the bar
• Fixed that you could Lose your beer when equipping Jetty Boots in Space Rig
• The barrel hoop will now kill you when jet booting up through it
• Fixed Glyphid Dreadnought (standard Dreadnought) armor broken
• Fixed Retrievable crossbow bolts don't emit ANY light as client
• Fixed Glyphid animation that raises forelegs overhead creates errant dirt particles mid-air
• Fixed bubbles in small bio tank
• Fixed Macteras missing dissolve animation on their corpse (this fix fixes the grabbers)
• Fixed crash when copy-pasting boscos loadout
• SMG now correctly tagged as Primary weapon in the weapon id

July 4th, 2023

• Optimized septic spreader puddles
• Fixed a bug that caused Subata 120 neuro-corrosive toxic catalyst exploders and lootbugs to briefly disappear before their own explosion
• Fixed beard and armor clipping that was introduced in last patch
• Fixed a bug that caused Corrupter boss music to keep playing
• Attempted fix for the triple bedazzled beard to clip less with armor
• Fixed a bug that caused Weapon stats to not update in Equipment Terminal when changing a non-selected class
• Fixed MC voice line in refinery mission after the liquid morkite extraction is done, if there are contagion spikes in the level
• Fixed a bug that caused shield sound to only play for host
• Fixed randomization of pickaxe when previewing classes
• Fixed that Corruptor worm pods did not spawn any worms
• Fixed a bug that caused the version number UI to be enabled on restart if it was previously turned off
• Fixed an issue where crossbow bolts would behave weirdly when shot at an elevator plant
• Fixed incorrect voice line playing when laser pointing maggots while Bosco is there
• Added 2 missing scrip by increasing plague challenges from 13 to 15
• Added a prompt to follow the Ghost Ship Games steam page when exiting the game
• Lowered the chances of MC, Bosco and others getting a highscore on the JettyBoot Arcade
• Fixed that plasma burster missiles were not working properly as client
• Fixed sleeveless using only hosts options in caves, should now handle local users settings

August 9th, 2023

• Fixed a crash that happened when leaving/disbanding team mid-steel drum concert
• Reduced the size of the terrain scanner model of the Pool Float
• Removed the extra pool float icon in the mission end screen
• Added eyebrows inside the industrial visor headwear
• Fixed a bug that caused the Shark hat to get the wrong material in some cases
• Fixed the Shark hat's teeth so they now don’t clip through all the eyebrows - and when they do it looks better
• Fixed French translation of the ‘launch bay/Baie de lancement’ text in the memorial hall.
• Re-fixed bug that made platform-sealed holes register as generated rooms, causing drops to land in unintended places and in some cases trigger the Escape Pod failsafe position.
• Fixed a bug that caused mission resources and XP to be granted double (stacking on top of the 2X Pool Float bonus) in some cases

August 10th, 2023

• Fixed a bug that caused minerals and carved terrain to become desynced between host and late- joining clients, if the corruptor was present in the level.
• Fixed a bug where the Stingtail would sometimes fling players way too high
• Fixed a bug that caused the season countdown timer to be visible if the game is offline/lost connection to the backend

September 7th, 2023

• Hid debug lines on specific corruptor attacks
• Fixed a bug that caused enemies to sometimes become stuck after spawning
• The amount of corruptors Plague puddles is now limited to a maximum of 30 active in a level.
• Fixed a bug that caused the meteor warning sound to not be played for clients
• Fixed a bug that caused ‘A Journeys End’ soundtrack to not be played on some systems
• Fixed a bug that caused liquid morkite wells and machine events to sometimes spawn too close, blocking the well access
• Fixed a bug that caused rock cracking pods to land inside each other
• Fixed a bug that caused hacking pods to land too close to other entities and colliding with them
• Prepared for upcoming events

September 8th, 2023

• Fixed a bug that caused corruptors Plague puddles to not be removed when vacuumed
• Added missing prices for season 03 forge items
• Fixed a bug that caused the oppressor and bulk detonator to very rarely spawn in the tutorial
• Fixed some typos

October 4th, 2023

• Fixed issue where some weapons could do massive amounts of damage when shooting a puddle
• Fixed that rejoin game would fail, if the host had previously hosted another game
• Adjusted Large meteor carver to make rock cracker locations more accessible without mining
• Fixed a few typos
• Optimized contagion spikes a bit
• Added a Merch tab to the menu, currently shows the DRG board game + expansion kickstarter

Patch 10 (November Maintenance Update)

November 16th, 2023

Toggle option for seasonal content

We’ve added the ability to opt out of Season content, for those of you that want to put your game into a ‘season neutral’ state. To unlock this ability, you need to reach level 100 in the Performance Pass, and claim the level 100 reward. After you do that, a check box option will become available in the Season Terminal interface. If you uncheck that box, here’s what happens:

• The Lithophage Corruption Zone will disappear from the map in your Mission Terminal.
• The chance of encountering Lithophage Outbreak Warnings on the map will become equal to other mission Warnings (like Rival Presence or Elite Threat, for example)
• Rockpox enemy waves will not spawn outside of Lithophage Warnings and Events
• The chance of Meteor Strike & Lithophage Corruptor events will become equal to previous season events (like the Rival Prospector)

Put simply, this option makes all Lithophage-related content as common as the Rival content currently is in the game. Doing this will also make it harder to obtain Plague Hearts and complete some Season Challenges, as these depend on Lithophage enemies and infestations. Keep in mind that when joining a lobby, it’s the host’s own season toggle setting that will apply to the session. This function is completely optional, and you can always turn it on or off whenever you like. We plan on keeping this feature for all future seasons.

Weapon Maintenance reward system

You’ll find a new tab in your Season Terminal: the Weapon Maintenance section. This is a bit of new content, meant to track and reward proficiency with the weapons in the DRG arsenal. The Weapon Maintenance screen tracks your experience with each gun in the game. Once you earn enough XP with a specific weapon equipped (counting toward both your primary and secondary in any mission), you’ll unlock exclusive paint jobs for that gun! We’re starting with four paintjobs to unlock, one for each season we’ve done so far. These new Weapon Mastery color schemes are:

• WM1 ‘Yellowjacket’
• WM2 ‘Cobalt Crackle’
• WM3 ‘Heroic’
• WM4 ‘Grasshopper’

This is going to be a seasonal feature, so with every new season in the future, there’ll be a special paintjob you can earn for every weapon. And these are never going to be season-locked – so you can always earn them for every gun, even if you don’t manage it before the next season rolls around.

Reductions of Rockpox effects

Rockpox boils

• Reduced the infection range when popping a boil
• Fixed the infection not stacking properly when popping multiple boils at once
• Reduced the amount of infection from popping a single boil

Rockpox infection buildup

• Shortened the delay before infection levels begin to drop
• Increased the infection reduction rate
• Reduced the time it takes to break out when being held by Rockpox
• Fixed the post-breakout infection immunity window not working properly
• Made the player infection buildup stop faster when players leave the source
• Fixed a bug that caused Rockpox buildup to never end
• Fixed a bug that caused Rockpox Exploders to not be feared by Litho-Foam
• Fixed players taking an extra tick of damage from the Rockpox immediately after breaking out

Rockpox Corruptor

• Improved the visibility of the stomp attack ‘tell’ particles
• Made it so that the spike attack 'tell' now shows the direction of attack
• Reduced the max movement speed
• Improved health bar damage feedback when hitting the vulnerable parts

Tweaks to enemy stats / behavior

• Improved the Septic Spreader's shot prediction, so it hits ceilings and other obstructions less often
• You can now shoot the Septic Spreader's projectiles out of the air
• Converted some of the Mactera Frost Bomber’s snowball projectile damage to ice damage
• Made the Glyphid Frost Praetorian do a little bit of damage with its ice breath attack
• Increased the cooldown of the grab attack slightly
• Added a significant cooldown after a successful grab attack
• Reduced the range of the grab attack
• Tweaked the base HP and added multiple damage weaknesses and resistances to improve breakpoints
• Removed health scaling by player count
• Fixed its horns not blocking damage
• Improved the collision on the "mouth" weak point, making it easier to hit
• Made the glowy armor bits glow more to improve visibility
• Tweaked the spawn values to prevent too many of them at once

New electrocution mechanics We updated the electrocution system to use the newer slowdown method, which allows enemies like the Dreadnoughts or Oppressor (who previously resisted electrocution completely) to instead partially resist and reduce the slowdown effect of electrocution while still taking damage from the DoT effect. In short, you can now electrocute these enemies. Zap!

Weapon tweaks

As always, any removed upgrades will have their cost automatically refunded. This also applies to the Necro-Thermal Catalyst upgrade for the Coil Gun, as we had to completely rebuild it.

Breach Cutter High Voltage Crossover OC

• Extended the duration of the electrocution effect from 4s to 5s

Roll Control OC

• Significantly increased the spin rate
• Added a lifetime bonus
• Projectile can now be steered while holding down the trigger
• Releasing the trigger no longer stops rotation, just releases steering control

Boomstick Shaped Shells OC

• Further tightened up the horizontal spread so now the grouping is symmetrical
• The crosshair now changes with this OC to reflect the spread change

LOK-1 Smart Rifle

• Fixed the input buffer not working properly when shooting manually
• Reduced the manual rate of fire of the LOK-1 now that it has a functioning input buffer, as the original value was high to compensate for the inconsistent firing.

ArmsKore Coil Gun

• Removed all randomness from the trail damage to get more consistency
• Increased the bonus radius of the T5 Dilated Injector upgrade from +0.5 to +1
• Made it so the base trail DoT effect can now stack
• Increased the maximum damage bonus from Overcharger from 32 to 100
• Added a damage bonus vs. burning targets on the T5 Necro Thermal Catalyst upgrade
• Increased the explosion radius of the T5 Necro Thermal Catalyst upgrade from 400 to 600 while reducing the damage from 140 to 80, and changed it to pure fire damage to better set enemies on fire and chain the effect
• Replaced the T2 reload speed upgrade with the T1 recharge speed upgrade, and moved some of the reload speed bonus to the base weapon
• Replaced the T1 charge speed upgrade with a new trail duration upgrade

Hellfire OC

• Removed the trail width bonus

Triple Tech OC

• Increased the damage dealt by the secondary shots from 0.5 to 0.75 (did not increase shot cost)

Backfeeding Module OC

• Replaced the damage penalty with a trail duration penalty

"Stubby" Voltaic SMG

• Reduced the base recoil slightly
• Reduced the bonus of the T2 recoil upgrade
• Increased the bonuses of the two damage upgrades
• Slightly reduced the bonus of the Hollow-Point Bullets upgrade
• Slightly reduced the bonus of the Conductive Bullets upgrade
• Added an armor breaking upgrade to T4
• Added an accuracy upgrade to T5
• Slightly reduced the accuracy penalty when walking and sprinting

Turret EM Discharge OC

• Removed friendly damage entirely
• Removed damage falloff
• Added a range indicator (visible only to player with the OC) that appears around every turret when the SMG is equipped

Turret Arc OC

• Significantly reduced the rate of friendly fire damage
• Completely removed the friendly fire from the AoE electrocution effect around any turret affected by Turret Arc
• Updated Turret Arc particles to better match the actual AoE radius
• Slightly increased the trigger size for the electric arc
• Added a short tail to the DoT to do a bit more damage to enemies that manage to quickly go through the arc
• Added a visual arc range indicator when placing turrets (only if you have the OC equipped)
• Added equipment loadout slot icons, so you can now use the mission type icons as a loadout icon
• Added more light reflection to the walls of Azure Weald and Hollow Bough to make it a little easier to see what’s going on
• Merch menu: New URL to the board game expansion entry (now links to the backer kit instead of the now-inactive Kickstarter page)
• Info landing screen: removed link to board game merch
• You can no longer activate the Jetty Boots Arcade in the Space Rig while holding an item
• Added Bloom and Lens Flare settings in the graphics options (you're welcome, J.J. Abrams)
• Added a Weapon Sway slider in the accessibility options
• Added a “Hold to Breakout” toggle in the accessibility options, for simpler Rockpox escapes
• Changed the trigger shape of all enemy-produced "puddles" (such as from Goo Bombers and Septic Spreaders) to better match the graphics and to make it easier to cover them with Engineer's platforms.
• Fixed not being able to grab Gunk Seeds while in the air (this was 98% of the whole update)
• Made it so the Full Fluffy beard no longer erases your sideburns
• Fixed a bug that caused Proximity Mines to put the player into a different character state when they pick them up
• Fixed that the +1 Satchel Charge upgrades did not work
• Sentry Gun ammo count now rounds up when resupplied
• Fixed issue with Driller not getting full Satchel Charges with resupplies
• Fixed beers getting a refill if you enter 3rd person (company policy is no free refills)
• Fixed a bug that caused Rockpox immunity after being knocked out
• Fixed a bug that caused a fizz sound to linger in empty beer mugs
• Fixed a bug that caused clients to get the promotion voice line when the host reached level 25
• Fixed incorrect Mission Control voicelines on Salvage Operations
• Fixed throwable items on the Space Rig (like snowballs) getting stuck in the carry animation if you threw them right before you entered 3rd person
• Fixed M1000 focus shot status effects not being applied to certain targets (e.g. Loot Bugs)
• Fixed Gamma Contamination (Wave Cooker OC) not working if you hit armor
• Fixed Mission Control shouting the wrong voice line when all pipelines are constructed
• Fixed a visual bug that made it look like the Dreadnought Twins could twin-heal with the Unknown Horror
• Fixed Q'ronar Shellback + Younglings briefly going into their reference pose (T-pose) when killed by fire, corrosive, Wave Cooker, or chemical explosion (from the Boltshark) before dying
• Fixed Hiveguard continuing its behavior after death
• Added a failsafe so that Fuel Cells dropping on top of the Uplink won't softlock the game
• Fixed a bug that made it so Salvage Mission fuel lines and Rock Cracker cables could be “split” or broken, which caused a softlock of the mission
• Fixed that the dwarves’ thick, magnificent necks were clipping through the Shock Trooper and Tech Trooper helmets
• Added a safety timer that will force the Hiveguard to spawn the Sentinels after a certain time has passed
• Fixed 5th Anniversary hat getting the color of the last hat you equipped
• Potential fix for Boltshark's ammo being weird in Deep Dives (hopefully not weird now)
• Potential fix for ammo not transferring between levels in Deep Dive (for turrets, shield, Satchel Charge and Boltshark bolts)
• Also tried to fix the Boltshark getting stuck in a state where it can't reload on 2nd level of Deep Dives
• Fixed Lederhosen first-person hands/gloves not looking right (now they’re Betterhosen)
• Reduced the range a Rock Cracker pod needs from another one, and improved fail-safe if the pods can't spawn
• Fixed Wave Cooker not properly gaining heat when spam-clicking
• Flare Gun’s flare sound now properly fades away when the flare burns out
• Clients now always see the same Mission Map as the host
• Fixed lingering ambient audio after leaving Deep Dive Terminal
• Fixed a bug where the Terrain Scanner would not get unequipped when the player stopped holding the button
• Fixed an equivalent bug for the Laser Pointer
• Fixed an issue for both the Laser Pointer and the Terrain Scanner when trying to use these items while holding something else
• Fixed bug where Boltshark bolts would stick to player when having the Bodkin Points OC equipped
• Added entry to Miner’s Manual for the Jetty Boot arcade game
• Slightly reduced the chance of the smol meteor event
• Fixed a bug where the Terrain Scanner would slide off the screen without the player releasing the button on high latency clients
• Changed the Terrain Scanner slide-on-screen animation so it no longer resets every time the player releases and holds the button
• Fixed an animation bug that caused the dwarf to move the weapon towards the center of the screen while walking, and view bobbing was not at maximum setting
• Improved EMP discharge indicator flow
• Fixed Cave Leeches’ hissing being too low quiet
• Fixed issue where Boltshark bolts that are shot at other projectiles get stuck in midair
• Sentry Turrets now turn off range indicators when dismantling themselves
• Tweaked escape menu to better fit non-English languages
• Fixed issue with perk equipper layout being weird in the Equipment Terminal
• Fixed issue where accuracy penalties when moving and sprinting were not always being applied

Phew, that's everything! Hope you like it. :) Have fun out there, be safe, and Rock and Stone!

• Fix for Corruptor crashing the game with it’s spike attack
• Possible fix for a crash when drinking beers and doing various mysterious things
• Fixed Hurricane Rocket Barrage OC not deactivating missile guidance

Weapon Maintenance mastery paintjobs

November 21st, 2023

• Potential fix for Unreal render crash that happened to many miners
• Fixed Machine Events not spawning
• Fix for a crash when using the Stubby
• Fix for Wardens are no longer warding as well as korlokk healing pod
• Potential crash fix for drinking certain beers and interacting with the spacerig (Management apologizes for the temporary lapse in morale)
• Fixed Burning Hell OC having the wrong heat-up rate bonus
• Fixed that Turret Arc has no effect on Shard Diffractor T5A upgrade

LMG Gun Platform

• Fixed ammo counters clipping through sentry guns when firing.
• Fixed potential crash and emp range indicator not turning on in specific cases.
• Fixed potential crash and issue where the arc range indicator is not turned on, on first equip of sentry gun item.

December 18th, 2023

• Fixed that mission control was talking about summer when finishing ‘The fashion of yuletide past’ assignment.
• Added an extra present, but don’t open it yet.
• Fixed an issue that caused networking not network in some rare cases.
• Attempt to fix Unreal render crash

January 4th, 2024

• Attempt at fixes crash for older gen Ryzen CPU’s
• Added additional logging

Changes from S04.12

• Fixed a Steam Socket issue that caused networking not network in some rare cases.

Patch 14 (February Maintenance Update)

February 19th, 2024

Introducing Hidden Dwarf beer

Fun stuff first: We’ve got a brand new brew up in the Abyss Bar!

Next time you mosey on over to the bar, you’ll find that Lloyd is ready to pour up a round of delicious Hidden Dwarf Double IPA.

After teasing it last week, it's been fun to see everybody’s speculations on what this beer does.

Some people speculated that it gives you Barrel Armor. This is not the case. Others guessed that it transforms you into a barrel. This is partially correct. A few thought they’d heard the Hydengözik Brewery name before. They have. Sort of.

So how can we describe this tantalizing new beverage? Well, to best experience the transformative flavor of Hidden Dwarf, we recommend you gather a few pals and order a round together.

You’ll find that it starts a prop hunt mode on the Space Rig. :)

Weapon tweaks and fixes

• The ‘Homebrew Explosive‘ mode has been changed to only affect radial damage on the weapon’s projectile.
• Therefore, it should no longer affect upgrades that do direct damage, such as the Spiky Grenade modification or the direct damage of the Hyper Propellant OC.
• Prior to the change, Homebrew Explosive had no effect on neither direct nor area damage of Hyper Propellant.
• Fixed a bug with the Cryo Cannon's T5A ‘Fragile’ mod, where shattered enemies didn’t die as expected on higher hazards
• Fixed a bug causing the Shard Diffractor’s ‘Bio-Mass Converter’ mod to not work for clients
• Fixed a bug with the Turret Arc OC where the electric damage bonus from Gemini turrets didn’t cause any additional damage when used with some other weapons
• Fixed a bug causing Turret EM Discharge OC to not proc at certain angles
• Fixed a bug that caused the Stubby’s ‘Upgraded Capacitors’ mod to roll two proc attempts with a 25% chance, instead of one roll with a 50% chance to proc. Basically, now there’s a higher chance to proc the electric effect

Armor and 'Armor Breaking' modifications

As discussed in the preview post, we’ve cooked up a few tweaks to make enemy armor behave more consistently, and give more incentive to pick the ‘Armor Breaking’ modification on your weapons.

• Fixed a bug where projectiles for the Deepcore 40mm PGL, DRAK-25, and Hurricane could hit an enemy and break the armor, but not damage the enemy in the same hit. This is a big day for Hyper Propellant enjoyers
• Fixed a longstanding bug where Heavy Armor (as found on the Praetorian) did not scale in accordance with Hazard level.
• Fixed a bug where the Boomstick’s ‘Improved Blast Wave’ mod did not deal damage to armor. The shockwave now uses radial damage instead of custom damage, so it should work against armor now.

General bug fixes

• Fixed a bug that caused Nayaka Trawlers (AKA sand sharks) to not target players unless damaged by players
• Fixed a bug that let players spam-deposit the same Kursite chunk over and over again, cheesing the Kursite Grinder event
• Fixed that Dreadnoughts were teleporting for clients in certain situations
• Fixed that Molly’s escape button would not appear in Industrial Sabotage missions if you completed the Contagion Spike cleaning objective last
• Fixed an issue where some AoE attacks themselves could be affected by status effects
• Fixed an issue that sometimes caused sleeves to not match the player’s loadout when displayed in the mission end screen
• Fixed a bug with doors on the Space Rig getting de-synced between players
• Fixed a bug where Mission Control would repeat On-Site Refining objective voiceline
• Fixed that the Grappling Hook would immediately pull Scout (ignoring the ‘casting’ time) when using Jet Boots
• Fixed a bug with the server list that caused Hazard 5 missions to always appear even when they should be locked, leading to new players accidentally joining Hazard 5 (lol)
• Fixed a bug that caused Bosco skins and frameworks to appear in Cargo Crates instead of the Lost Packs as intended.

QoL features

• Experience earned for Weapon Maintenance skin rewards now carries over to other unlock levels. Now you can earn everything without having to check in and ‘redeem’ stuff you’ve already unlocked. A more detailed description is available in the preview post
• Reorganized the audio options, so there’s a stronger visual indicator that the ‘Character’ & ‘Mission Control’ volume sliders are both subject to the ‘Sound Effects’ volume slider
• The menu’s Audio tab now has a ‘Steam settings’ button for easier access to Steam’s own audio settings
• Remaned the Merch tab in the menu to “DRG Universe” and added a new module for Deep Rock Galactic: Survivor
• Got the Miner Community terminal's Discord integration to work more consistently (still can be a bit wonky, but at least it's better)
• Adding a small monitor near the Assignment Board that displays a countdown until a current seasonal event ends. This will first be visible during this year’s Anniversary Event. More on that real soon!

And fixed some typos, probably made some new ones

Newly added beer!

February 20th, 2024

• Options: Added more space for percentage text for volume sliders
• Fixed a bug that caused Boomstick mod ‘Improved Shockwave’ tooltip showing 0 damage.
• Prop Hunt: Hunters can now rock & stone
• Prop Hunt: Fixed a bug that caused the bio tank prop to hover above the floor
• Removed a visible box surrounding Engineers Lure Grenade
• Fixed a crash when failing a mission while wearing sleeveless armor
• Pages using Tabber parser tag
• Pages with broken file links

Mastering MS-DRG Assignments to Enhance Reimbursements

Executives of hospital management often overlook medical coding as a contributing factor to the revenue cycle – but it’s a crucial link between earning well-deserved reimbursements from the services performed. One such revenue-defining coding system is the Medicare Severity Diagnosis Related Group (MS-DRG), which utilizes ICD-10 diagnosis and procedure codes , and other factors, such as age, sex, and discharge disposition, to facilitate payment for Inpatient services. In this introduction to MS-DRG assignments, we’ll explore examples of DRGs and introduce invaluable resources for selecting the correct DRG, including a DRG list and DRG assignment software.

What is Medicare Severity Diagnosis Related Group (MS-DRG) Coding?

MS-DRG is a sophisticated classification system that holds the power to categorize patients and their medical cases based on clinical characteristics and the resources required for their care (CMS, 2023). Each patient’s case is assigned a specific DRG, encapsulating diagnoses, procedures, age, sex, MCCs, CCs, and other relevant factors. These codes effectively communicate the complexity and intensity of services provided, determining reimbursement levels for hospital stays. Introduced by the Centers for Medicare and Medicaid Services (CMS), this system streamlines the payment process for Inpatient services.

It serves as a universal language, allowing healthcare providers to effectively communicate the complexity and intensity of services rendered. By assigning specific DRGs to patient cases, hospitals can accurately capture the intricacies of each scenario, leading to fair reimbursement and improved financial outcomes.

Accurate DRG assignment plays a pivotal role in directly impacting a hospital’s or facility’s reimbursements and revenue cycle. Accurate and appropriate DRG assignment ensures that the severity and complexity of each patient case are effectively communicated, leading to proper reimbursement for the resources invested in their care. By assigning the correct DRG, hospitals can optimize their revenue potential by capturing the true value of the services provided.

Additionally, accurate DRG assignment helps healthcare organizations navigate complex payment structures and regulatory guidelines, reducing the risk of undercoding or overcoding, which can result in financial penalties or revenue loss. A streamlined and efficient revenue cycle relies heavily on accurate DRG assignment, ensuring that hospitals receive fair and adequate reimbursements for the care they deliver while maintaining financial stability and sustainability.

DRG Examples

To grasp the practical application of DRG assignments, let’s explore some examples.

Patient admitted with the principal diagnosis of acute myocardial infarction is impacted when a percutaneous cardiovascular procedure is performed with drug-eluting or non-drug eluting stents or arteries.

DRG 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS DRG 247 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITHOUT MCC DRG 248 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS DRG 249 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH NON-DRUG-ELUTING STENT WITHOUT MCC

MDC 05 Disease and Disorders of the Circulatory System

Percutaneous Cardiovascular Procedures with Coronary Artery/Stent Decision Tree

Patient admitted with the principal diagnosis of acute myocardial infarction is impacted when the patient has a major complication or comorbidity (MCC) or complication and comorbidity (CC) or not and whether the patient was discharged alive or expired.

DRG 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC DRG 281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC DRG 282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC DRG 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC DRG 284 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC DRG 285 ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Acute Myocardial Infarction and Principal Diagnosis Decision Tree

Patient admitted with the principal diagnosis of pneumonia is impacted when the patient has a major complication or comorbidity (MCC) or complication and comorbidity.

DRG 193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC DRG 194 SIMPLE PNEUMONIA AND PLEURISY WITH CC DRG 195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

MDC 04 Diseases and Disorder of the Respiratory System

Simple Pneumonia as the Principal Diagnosis Decision Tree

DRG Resources

Here are several DRG resources to assist with appropriate assignment:

MS-DRG List:  This comprehensive DRG list from CMS includes  a vast range of codes  representing various medical cases, diagnoses, procedures, and patient profiles. This list enables healthcare providers to accurately assign the most suitable DRG, streamlining the reimbursement process and optimizing financial outcomes.

MS-DRG Grouper Software : An invaluable tool in correctly assigning DRGs is the MS-DRG Grouper software. The software calculates payments to cover the costs of an Inpatient encounter. The coder enters the ICD-10-CM/PCS codes into the software, and it calculates the MS-DRG based on those codes the user has selected. The MS-DRG payment equals the MS-DRG relative weight multiplied by the hospital blended rate.

Utilize Our Coding Support Services to Assign DRGs & Optimize Revenue

YES offers expert coding support services for DRG assignment, designed to streamline providers’ processes, ensure compliance, and maximize revenue potential. Here’s why you should choose our services:

• Expertise and Experience : Our highly skilled team of certified coding professionals possesses extensive knowledge and experience in coding and assigning DRGs. We remain current with the latest industry regulations and guidelines, guaranteeing accurate and comprehensive coding to maximize reimbursements.
• Compliance and Audit Readiness : We recognize the importance of compliance in healthcare. Our services ensure that your coding practices align with regulatory guidelines, safeguarding your organization from penalties and preparing you for any compliance audits.
• Revenue Optimization : By leveraging our DRG assignment and coding support services, you unlock the full revenue potential of your organization. Utilizing our customized trending reports, we identify areas for improvement, minimize coding errors, and provide actionable insights to enhance financial performance.

Mastering DRG assignment is essential for hospitals and healthcare organizations to achieve optimal reimbursements and operational efficiency.  Contact us today  to discuss how our  coding support services  can elevate your coding practices and drive superior outcomes.

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How Your DRG Is Determined

Frank and Helena/Getty Images

Medicare and many health insurance companies pay hospitals using DRGs, or diagnostic related groupings . This means the hospital gets paid based on the admitted patient’s diagnosis and prognosis, rather than based on what it actually spent caring for the hospitalized patient.

This article will explain how DRGs are determined and how this affects your medical bills.

If a hospital can treat a patient while spending less money than the DRG payment for that illness, the hospital makes a profit. If, while treating the hospitalized patient, the hospital spends more money than the DRG payment, the hospital will lose money on that patient’s hospitalization. This is meant to control healthcare costs by encouraging the efficient care of hospitalized patients.

Why You Should Care How a DRG Is Determined

If you’re a patient, understanding the basics of what factors impact your DRG assignment can help you better understand your hospital bill, what your health insurance company or Medicare is paying for, or why you’ve been assigned a particular DRG.

If you’re a physician rather than a patient, understanding the process of assigning a DRG can help you understand how your documentation in the medical record impacts the DRG and what Medicare will reimburse for a given patient’s hospitalization. It will also help you understand why the coders and compliance personnel ask you the questions they ask.

Steps for Determining a DRG

This is a simplified run-down of the basic steps a hospital’s coder uses to determine the DRG of a hospitalized patient. This isn’t exactly how the coder does it; in the real world, coders have a lot of help from software.

• Determine the principal diagnosis for the patient’s admission.
• Determine whether or not there was a surgical procedure.
• Determine if there were any secondary diagnoses that would be considered comorbidities or could cause complications. A comorbid condition is an additional medical problem happening at the same time as the principal medical problem. It might be a related problem, or totally unrelated.

These steps are illustrated in a flow chart on page 15 of this CMS document . The DRG will also reflect various nuances related to the patient's healthcare needs, including the severity of the condition, the prognosis, how difficult or intensive the treatment is, and the resources necessary to treat the patient.

Let’s say elderly Mrs. Gomez comes to the hospital with a broken femoral neck, known more commonly as a broken hip . She requires surgery and undergoes a total hip replacement . While she’s recovering from her hip surgery, her chronic heart problem flares up and she develops acute systolic congestive heart failure . Eventually, her physicians get Mrs. Gomez’s heart failure under control, she’s healing well, and she’s discharged to an inpatient rehab facility for intensive physical therapy before going back home.

Mrs. Gomez’s principal diagnosis would be a fracture of the neck of the femur. Her surgical procedure is related to her principal diagnosis and is a total hip replacement. Additionally, she has a major comorbid condition: acute systolic congestive heart failure.

When the coder plugs all of this information into the software, the software will spit out a DRG of 469 , entitled “Major Joint Replacement or Reattachment of Lower Extremity With MCC.” The "MCC" stands for "major complication or comorbidity" and it's applicable in this case because of the cardiovascular problems that Mrs. Gomez experienced during her hospital stay.

More About Step 1: Principal Diagnosis

The most important part of assigning a DRG is getting the correct principal diagnosis. This seems simple but can be tough, especially when a patient has several different medical problems going on at the same time. According to the Centers for Medicare and Medicaid Services (CMS), “The principal diagnosis is the condition established after study to be chiefly responsible for the admission.”

The principal diagnosis must be a problem that was present when you were admitted to the hospital; it can’t be something that developed after your admission. This can be tricky since sometimes your physician doesn’t know what’s actually wrong with you when you’re admitted to the hospital.

For example, maybe you’re admitted to the hospital with abdominal pain, but the doctor doesn’t know what’s causing the pain. It takes her a bit of time to determine that you have colon cancer and that colon cancer is the cause of your pain. Since the colon cancer was present on admission, even though the physician didn’t know what was causing the pain when you were admitted, colon cancer can be assigned as your principal diagnosis.

There are also times when a patient is admitted to the hospital with two or more conditions that each meet the definition of principal diagnosis. There are protocols in place that the doctor and coders use to ensure that the conditions are actually equally qualified to be the principal diagnosis, but if they are, both conditions are coded but either one can be selected as the principal diagnosis.

More About Step 2: Surgical Procedure

Although this seems cut and dry, like most things about health insurance and Medicare, it’s not. There are a couple of rules that determine if and how a surgical procedure impacts a DRG.

First, Medicare defines what counts as a surgical procedure for the purposes of assigning a DRG, and what doesn’t count as a surgical procedure. Some things that seem like surgical procedures to the patient having the procedure don’t actually count as a surgical procedure when assigning your DRG.

Second, it’s important to know whether the surgical procedure in question is in the same major diagnostic category as the principal diagnosis. Every principal diagnosis is part of a major diagnostic category, roughly based on body systems.

If Medicare considers your surgical procedure to be within the same major diagnostic category as your principal diagnosis, your DRG will be different than if Medicare considers your surgical procedure to be unrelated to your principal diagnosis. In the above example with Mrs. Gomez, Medicare considers the hip replacement surgery and the fractured hip to be in the same major diagnostic category.

More About Step 3: Comorbid Conditions and Complications

Since it uses more resources and likely costs more to care for a patient like Mrs. Gomez who has both a broken hip and acute congestive heart failure than it does to care for a patient with a broken hip and no other problems, the DRG protocol takes this into account.

A comorbidity is a condition that existed before admission, and a complication is any condition that occurred after admission, not necessarily a complication of care.  

Medicare even distinguishes between major comorbid conditions like acute congestive heart failure or sepsis, and not-so-major comorbid conditions like an acute flare-up of chronic COPD. This is because major comorbid conditions require more resources to treat than not-so-major comorbid conditions do. In cases like this, there may be three different DRGs, known as a DRG triplet:

• A lower-paying DRG for the principal diagnosis without any comorbid conditions or complications.
• A medium-paying DRG for the principal diagnosis with a not-so-major comorbid condition. This is known as a DRG with a CC or a comorbid condition.
• A higher-paying DRG for the principal diagnosis with a major comorbid condition, known as a DRG with an MCC or major comorbid condition.

If you’re a physician getting questions from the coder or the compliance department, many of these questions will be aimed at determining if the patient was being treated for a CC or MCC during his or her hospital stay in addition to being treated for the principal diagnosis.

If you’re a patient looking at your bill or explanation of benefits and your health insurance company pays for hospitalizations based on the DRG payment system, you’ll see this reflected in the title of the DRG you were assigned.

A DRG title that includes “with MCC” or “with CC” means that, in addition to treating the principal diagnosis you were admitted for, the hospital also used its resources to treat a comorbid condition during your hospitalization. The comorbid condition likely increased the resources the hospital had to use to treat you, which is why the hospital was paid more than they would have received if you'd only had a single diagnosis and no comorbid conditions.

Hospital Base Rates and DRG Relative Weights

DRGs are assigned a relative "weight," which reflects how resource-intensive it is to treat the patient. The average weight is 1.0. DRGs with weights above 1 require more resources, while DRGs with weights below 1 are, in general, less costly to treat.

In addition, each hospital has a base rate, which is determined based on factors such as location (labor and overhead costs are higher in some areas than in others), whether it's a teaching hospital, whether it's in a rural and/or underserved area, and the percentage of uninsured patients the hospital sees.

The DRG's relative weight and the hospital's base rate are both included int the formula that determines how much the hospital will get paid.

When a Medicare patient is hospitalized, a diagnostic-related category (DRG) code is assigned based on the patient's condition (private insurers can also use DRGs or similar coding protocols). DRGs are based on the patient's principal diagnosis (ie, the primary reason they're admitted to the hospital), any surgical procedures, and any comorbidities that complicate the treatment or add to the resources needed to care for the patient.

DRGs are assigned a relative weight, reflecting how costly/resource intensive the treatment is. And hospitals also have different base rates, reflecting various factors that impact their overhead costs.

The DRG and the hospital's base rate are both taken into account during the billing and payment process, and are used to determine how much the hospital will be paid. The patient's share of the bill will generally depend on the specifics of their health plan and whether they have supplemental coverage.

A Word From Verywell

Although the DRG determination process is complex, you don't have to know the details of exactly how it works. As far as the patient is concerned, the important details include using an in-network hospital and understanding how your health plan's  cost-sharing  works (deductible, coinsurance, and out-of-pocket maximum are the factors that generally come into play with inpatient care). And if you have Medicare and are going to need follow-up care in a skilled nursing facility, you'll also want to understand the difference between inpatient and observation care .

ACP Hospitalist and American College of Physicians. The ABCs of DRGs .

Centers for Medicare and Medicaid Services.  Design and development of the Diagnosis Related Group (DRG) .

Department of Health and Human Services. Centers for Medicare and Medicaid Services. CMS manual system. pub. 100-04: medicare claims processing .

Williams, Lee. AAPC. Determine the Principal Diagnosis Code in the Inpatient Setting . January 2, 2019.

Centers for Medicare and Medicaid Services. ICD-10-CM/PCS MS-DRG v37.0 Definitions Manual .

By Elizabeth Davis, RN Elizabeth Davis, RN, is a health insurance expert and patient liaison. She's held board certifications in emergency nursing and infusion nursing.

Appendix C is a list of all of the codes that are defined as either a complication or comorbidity (CC) or a major complication or comorbidity (MCC) when used as a secondary diagnosis.

Part 1 lists these codes. Each code is indicated as CC or MCC. A link is given to a collection of diagnosis codes which, when used as the principal diagnosis, will cause the CC or MCC to be considered as only a non-CC.

Part 2 lists codes which are assigned as a Major CC only for patients discharged alive. Otherwise they are assigned as a non-CC.

Part 3 lists diagnosis codes that are designated as a complication or comorbidity (CC) or major complication or comorbidity (MCC) and included in the definition of the logic for the listed DRGs. When reported as a secondary diagnosis and grouped to one of the listed DRGs the diagnosis is excluded from acting as a CC/MCC for severity in DRG assignment.

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3M™ All Patient Refined Diagnosis Related Groups (3M APR DRG)

3M APR DRGs are the standard for inpatient classification.

Providing an accurate, consistent measure to evaluate inpatient care.

3M sets the standards with more than 35 years of experience. Nobody understands severity and risk-adjustment methodologies better. We built them. We develop and refine them. We know how they impact your organization. And we can show you how to use them to improve quality of care, lower costs and improve population health.

Why choose the 3M APR DRGs?

3M APR DRGs are the only inpatient classification methodology that is suitable for all patient populations, including sick and healthy newborns, pediatrics and obstetrics. These populations represent 41 percent of privately insured stays and 52 percent of Medicaid stays, but just 0.3 percent of Medicare stays. The Medicare program has specifically advised other payers not to use Medicare DRGs as they were designed specifically for the Medicare recipients and are not inclusive for these populations. 

3M APR DRGs define "the product of a hospital." Each of the 332 base 3M APR DRGs classifies patients based on clinical similarities and their use of hospital resources. Further, each base 3M APR DRG is divided into four levels of severity of illness, for a total of 1,330 3M APR DRGs (including 2 error DRGs). This clear and understandable structure enables insight and communication with clinicians.

The logic to assign a patient to one of four severity levels depends on the number, nature and interaction of complications and comorbidities (CCs) for that base 3M APR DRG specifically. By contrast, in the Medicare DRG methodology, each base DRG has at most three severity levels, which are assigned based on the simple presence of a CC or a major CC. As a result, the 3M APR DRGs are a more accurate measurement of severity even for cardiac, respiratory and other patient types often covered by Medicare.

3M APR DRGs are closely integrated with other 3M methodologies used to measure hospital performance in terms of potentially preventable complications, potentially preventable readmissions and mortality. These quality measures, as well as efficiency measures such as cost per stay, are risk adjusted using 3M APR DRGs to enable impartial comparisons across hospitals and other inpatient populations. 3M APR DRGs are also used to define inpatient stays in measuring population health (i.e., potentially preventable admissions) and as anchors in defining episodes of care.

All about 3M APR DRGs

The 3M APR DRG methodology is critical to appropriate inpatient classification

3M APR DRGs have become the standard across the U.S. for classifying hospital inpatients in non-Medicare populations. As of February 2023, 29 state Medicaid programs use 3M APR DRGs to pay hospitals, as do approximately a dozen commercial payers. More than 2,400 hospitals have licensed 3M APR DRG reimbursement calculation software to verify payment and analyze internal operations.

The 3M APR DRG methodology classifies hospital inpatients according to their reason for admission, severity of illness and risk of mortality.

3M APR DRGs are used by payers, hospitals and researchers. Payers often use 3M APR DRGs as the basis for an inpatient prospective payment method and as the risk adjustor in measuring hospital quality. Hospitals often use 3M APR DRGs in combination with 3M reimbursement calculation software to predict and verify expected reimbursement. Hospitals and researchers use 3M APR DRGs to understand utilization, measure quality and calculate efficiency measures such as risk-adjusted cost per stay.

Here are a few examples of how the 3M APR DRG patient classification methodology can bring value to health care organizations.

• Appropriate payment incentives. Implementing a 3M APR DRG payment method rewards efficiency, because payment does not depend on hospital-specific costs or charges. At the same time, a 3M APR DRG payment method creates incentives to increase access to care, because higher severity 3M APR DRGs receive higher payment rates.
• Predict and verify expected payment. 3M makes available reimbursement calculation software that enables providers to predict and verify expected payment using a specific payer’s 3M APR DRG pricing policy.
• Public reporting. Because 3M APR DRGs define “the product of a hospital,” they are useful in public reporting and other comparisons across hospitals and states. New York state, for example, uses 3M APR DRGs to report average charges and costs for every hospital in the state.
• Quality comparisons. 3M APR DRGs have been used in multiple analyses as the risk adjustor to make fair comparisons across hospitals on quality measures such as mortality, potentially preventable complications and potentially preventable readmissions.
• Clinical insight. Hospitals, state agencies, payers and researchers use 3M APR DRGs to yield insights about clinical care. For example, analysis in multiple states has quantified the sharp inverse relationship between birth weight and the hospital’s cost of neonatal care.
• Financial analysis. Hospitals, state agencies, payers and researchers use 3M APR DRGs to risk adjust measures such as charges, hospital cost and average length of stay to create fair comparisons of utilization and efficiency across service lines, hospitals and other populations.
• Defining episodes. The event of an inpatient stay is used in the 3M™ Patient-focused Episodes (PFE) Software to define an episode of care that includes the inpatient stay, the associated hospital and professional services, and related post-discharge services (such as rehabilitation).

3M APR DRG grouping logic is the same for every payer, although different payers choose different configuration options and may follow different update schedules. Each payer that uses 3M APR DRGs makes its own decisions about prices and payment policies. For hospitals, other providers, health plans and other organizations that seek to understand, predict and verify expected payment, 3M makes available software that emulates payer-specific grouping, pricing and payment policy. As of 2021, this payment prediction software is available for approximately 30 payers nationwide.

See what payer-specific grouping and payment prediction software is available by state .

3M also makes available reimbursement calculation software for national payers that do not use 3M APR DRGs, including Medicare DRGs and TRICARE DRGs.

3M APR DRGs are integrated with other 3M patient classification methodologies.

3M has aligned the service line definitions between 3M APR DRGs for inpatient care and the 3M™ Enhanced Ambulatory Patient Groups (EAPGs) for outpatient care. This alignment allows analysis of charges, cost, payment and utilization by service line across both inpatient and outpatient settings.

3M APR DRGs are used to risk adjust the 3M™ Potentially Preventable Complications (PPCs) and 3M™ Potentially Preventable Readmission (PPR) methodologies . 3M PPCs measure the incidence of a wide range of inpatient complications while 3M PPRs are a well-accepted measure of the quality of both inpatient care and post-discharge follow-up in the community.

3M APR DRGs are used to define 3M™ Potentially Preventable Admissions , which are a measure of population health.

3M APR DRGs are used to define certain 3M PFEs . For example, 3M APR DRG 301-1 Hip Joint Replacement triggers Patient-focused Episode 3011 Hip Replacement Procedure.

3M APR DRGs are available in the following 3M products:

• 3M™ 360 Encompass™ System
• 3M™ Coding and Reimbursement System
• 3M™ Advanced CDI Transformation Program
• 3M™ Clinical Documentation Improvement (CDI) System
• 3M™ Reimbursement Calculation Software
• 3M™ Core Grouping Software (CGS)
• 3M™ Grouper Plus Content Services (GPCS)
• 3M™ Data to Action Solution
• 3M™ APR DRG mainframe version

Licensees of the 3M APR DRG methodology have access to the following documents on the 3M Customer Support website:

• 3M™ APR DRG Methodology Overview
• 3M™ APR DRG Summary of Changes
• 3M™ APR DRG Definitions Manual
• 3M™ APR DRG Software Installation and User’s Guide
• 3M™ APR DRG Weights and Trims with Code Descriptions

3M experts are available to advise provider organizations, health plans, government agencies and other interested parties on how to obtain maximum value from using the 3M APR DRGs. For example, 3M consultants can help hospitals implement clinical documentation integrity (CDI) programs and use 3M APR DRGs to measure and improve their own cost efficiency and quality of care. 3M consultants can also help payers design payment methods based on 3M APR DRGs and demonstrate how to use 3M APR DRGs to understand patterns of utilization, charges, cost and payment.

The unit of analysis is an inpatient stay at an acute care hospital. All the data required to assign a 3M APR DRG can be obtained from a standard inpatient hospital discharge record, such as the UB-04 form or the X12N 837I electronic transaction. Data fields that are particularly important for 3M APR DRG assignment include all diagnosis codes, present on admission indicators, ICD-10-PCS procedure codes and procedure code date.

3M APR DRGs were first released in 1991. The 3M APR DRG logic uses claims data to assign patients to one of 332 base 3M APR DRGs that are determined either by the principal diagnosis or, for surgical patients, the most important surgical procedure. Each base 3M APR DRG is then divided into four severity of illness (SOI) levels, determined primarily by secondary diagnoses that reflect both comorbid conditions and the severity of the underlying illness, creating the final set of 1,330 3M APR DRGs. The 3M APR DRG logic computes both an admission severity of illness and a discharge severity. The present-on-admission (POA) indicator for each secondary diagnosis is a required data field for computing the severity of illness at the time of admission.

For example, 3M APR DRG 139-1 is Other Pneumonia, severity of illness 1 (minor) while 3M APR DRG 139-4 is Other Pneumonia, severity of illness 4 (extreme). Each base DRG also has four risk-of-mortality levels. Although severity of illness is often correlated with risk of mortality, the two concepts are different and it is possible for a patient to have a high severity of illness but a low risk of mortality. Acute cholecystitis is an example.

The clinical logic is maintained by a team of 3M clinicians, data analysts, programmers and economists. The logic is proprietary to 3M but is available for licensees to view in an online definitions manual.

Each year 3M calculates and releases a set of statistics for each 3M APR DRG based on our analysis of large national data sets. These statistics include a relative weight for each 3M APR DRG. The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations. The 3M APR DRG statistics also include data for each 3M APR DRG on relative frequency, average length of stay, average charges and incidence of mortality.

3M APR DRGs can be rolled up into broader categories. The 332 base DRGs roll up into 25 major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System. As well, each 3M APR DRG is assigned to a service line that is consistent with the outpatient service lines that are defined by the 3M™ Enhanced Ambulatory Patient Groups (EAPGs) . An example is service line 01.7, General Medicine – Pulmonary.

3M releases a new version of the 3M APR DRGs every October 1, to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements to the clinical classification logic.

Learn more about 3M APR DRGs

Publicly available documentation, articles and reports

Please note that documents not published by 3M do not necessarily reflect 3M recommendations and have not been approved by 3M. These documents are listed here for the information of readers interested in the various ways that 3M patient classification methodologies have been applied. Also note that listing these references does not imply endorsement of 3M methodologies by individual authors, other organizations or government agencies.

Some articles and reports are available from the publishers at no charge, while others require a fee.

This methodology overview details how 3M APR DRG classify hospital inpatients according to their reason for admission, severity of illness and risk of mortality.

See why 3M APR DRGs are so popular among payers, providers and researchers.

3M™ Enhanced Ambulatory Patient Groups (EAPGs) a specifically designed bundled payment appropriate for all ages of patients and the health care provided to them. 3M EAPGs are most appropriate for Medicaid and commercial populations, for example, neonate, maternity and dental care can be accommodated in 3M EAPGs.

Read about the beginnings of 3M DRGs in case mix and resource use theory, to their implementation for payment and now for their current utilization for quality within and outside the hospital.

View full lists of 3M APR DRG descriptions, MDC and Type.

APR DRG v41.0 descriptions

The 3M DRG experience offers lessons about the effectiveness of financial incentives, the likelihood of adverse effects, the usefulness of case mix measures, the risks of growing complexity and the example that sensible policy need not be the domain of any one political party or other entity.

3M researchers analyzed 30-day mortality after a surgical procedure for two million Medicare inpatients in 2018. Even after clinical risk adjustment, extensive variation in quality outcomes was found across states and hospital types. Hospitals with higher surgical volumes tended to have better quality.

In 2013, California Medicaid reformed its inpatient payment method, with clinical grouping based on 3M APR DRGs and payment policies determined by the state. The payment method is extensively documented on this webpage, including the 2013 policy design document and annual interactive pricing calculators.

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Hospital Patient Financial Services

Description of coding and drg assignment.

nsforming the verbal description of disease, injuries and procedures into numerical codes. Every patient encounter will be assigned these numerical codes based on the review of the provider’s documentation. Therefore all diagnostic or procedural statements should be accurate , specific, complete and descriptive of the patient’s condition. Accurate documentation results in accurate coding which is essential to reflect the severity of illness, complexity of care provided and consumption of resources.

These codes are utilized and reported both internally and externally. Codes and the data generated from coding are used internally for reimbursement, strategic and fiscal planning, clinical research, assessment of quality, physician profiling and other clinical and administrative purposes.

These same codes and data generated from coding are reported externally to various public and private agencies, such as Medicare/ Medicaid, Texas Medical Foundation, Census Bureau, State and Local Health Departments as well as many national ranking or benchmarking institutions including but not limited to Leap Frog Group, University Healthsystem Consortium, Hospital Compare, Healthgrades and others.

All codes are assigned by highly skilled and trained individuals nationally certified to perform Coding. Code assignment is dictated by the Rules and Guidelines established and updated annually by the Federal Government. Not adhering to these guidelines for documentation and coding constitutes fraud and is subject to prosecution.

A few of these guidelines/definitions that are important for you to be familiar with are listed below:

All Diagnosis that affect the current patient encounter must documented and coded. This requirement includes conditions that coexist at the time of admission or develop subsequently and affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier admission, but which have no bearing on the current admission are to be excluded from coding. Diagnosis that are suspected and are treated empirically or cannot be ruled-out are to be included as diagnostic statements in the patient’s record and coded accordingly. Signs, symptoms and observations should be documented as a diagnosis whenever possible to provide adequate substantiation of coding for severity of illness and risk of mortality.

All diagnostic statements should be accurate , specific, complete and descriptive of the patient’s condition.

Significant Procedure : A significant procedure is one that carries an operative or anesthetic risk or requires highly trained personnel or special equipment. All significant procedures are to be documented in the patient record. (see Procedure&Operative Notes)

Codes are sequenced into Diagnoses Related Groups (or DRGs) to determine reimbursement from third party payers. DRGs are determined by the principal procedure, or the principal diagnosis if no procedure exists, and the presence of other conditions.

DRGs group patients with similar resource consumption, severity of illness and length of stay into payment groups.

DRGs are used for determining reimbursement and as an indicator for other types of reporting such as budgeting, physician profiling, clinical outcomes, case mix calculation and clinical research.

Description of Outpatient Hospital Coding

Coding is transforming the verbal description of disease, injuries and procedures into numerical codes. Every patient encounter will be assigned these numerical codes based on the review of the provider’s documentation. Therefore all diagnostic or procedural statements should be accurate , specific, complete and descriptive of the patient’s condition. Accurate documentation results in accurate coding which is essential to reflect the severity of illness, complexity of care provided and consumption of resources

All codes are assigned by highly skilled and trained individuals nationally certified to perform Coding. Code assignment is dictated by the Rules and Guidelines established and updated annually by the Federal Government. Not adhering to these guidelines for documentation and coding constitutes fraud and is subject to criminal prosecution.

• Hospital Outpatient coders code the following services:
• Day Surgery that are not admitted to inpatient
• Observation encounters not changed to a full admit
• Labor&Delivery Triage
• PT/OT services
• Outpatient Lab that requires a diagnostic code for reimbursement
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Q&a: unrelated surgical procedure drgs.

Q:  Could you please explain unrelated surgical procedure DRGs? Also can you explain how we can differentiate between extensive operating room (OR) procedure and non-extensive OR procedure.   

A:  Many CDI specialists with a clinical background are “encoder dependent,” trained to “code” using an encoder and taught to create a working MS-DRG based on “grouper” software. However, CDI specialists should understand how to manually assign a MS-DRG, too. The basics steps for assigning a MS-DRG are.

• Identify all the reportable diagnoses in the health record and assign their applicable ICD code (we currently use ICD-9-CM, but will transition to ICD-10-CM)
• Identify the principal diagnosis (the condition “after study” determined to be chiefly responsible for occasioning the admission), the remaining diagnoses are secondary diagnoses some of which may be classified by CMS as a complicating or comorbidity (CC) or major complication or comorbidity (MCC)
• Use the alphabetic index of diagnoses in the  DRG Expert  to identify the base/medical MS-DRG noting its Major Diagnostic Category (MDC)/body system (the MDC is necessary to assign the surgical MS-DRG when applicable) by scanning the MS-DRGs associated with the listed pages to see which applies to the particular scenario
• Identify any/all reportable procedures and their associated procedure code (ICD-9-CM Vol. 3 until we transition to ICD-10-PCS)

The UHDDS (Uniform Hospital Discharge Data set) defines reportable diagnoses and procedures. Most coders and CDI specialists are familiar with the definitions associated with diagnoses, but less familiar with those associated with procedures. Only  significant  procedures need to be reported. According to UHDDS, a significant procedure is one that is:

• Surgical in nature, or
• Carries a procedural risk, or
• Carries an anesthetic risk, or
• Requires specialized training

In addition, UHDDS also defines the  principal  procedure as:

• One that was performed for definitive treatment, rather than one performed for diagnostic or exploratory purposes, or was necessary to take care of a complication
• If two procedures could be principal, then the one most related to the principal diagnosis should be selected

The UHDDS definitions of significant procedures is helpful because not all procedures will affect the MS-DRG. Some procedures won’t have any impact on the MS-DRG, some procedures will change the based medical MS-DRG, and some procedures will move the case to a surgical MS-DRG.

Procedures that are diagnostic in nature are less like to impact the MS-DRG assignment because they are typically performed in the outpatient setting, which is why they are less likely to be the principal procedure. Also, the principal procedure is usually related to the principal diagnosis, meaning they usually can be found in the same MDC/body system. ICD-10-PCS has specific guidelines regarding the assignment of the principal procedure.

If a procedure was performed, determine if it is significant:

• If there are multiple significant procedures determine the principal procedure
•  It is not a “reimbursable” procedure (i.e., one that will not affect the MS-DRG assignment)
• It a major operating room procedure

Let’s explore the first situation, when the procedure doesn’t affect MS-DRG assignment. In this situation, finalize the base medical MS-DRG by checking the impact of secondary diagnoses. Are there any that are classified as CCs or MCCs? Are there any query opportunities to add a diagnosis that can affect the MS-DRG? Once the secondary diagnoses are addressed, the working MS-DRG is established, which can be revised as additional secondary diagnoses and/or procedures occur during the admission.

More often than not, the procedure code will be in the numeric index of procedures. The index lists possible associated MS-DRGs. If more than one page is listed, check each of the possible associated MS-DRGs to see if any are located in the same MDC as the principal diagnosis (this is why it was important to note the MDC when assigning the base medical MS-DRG).

As long as the procedure maps to a MS-DRG that is in the same MDC as the principal diagnosis the applicable MS-DRG can be assigned. Finalize the working MS-DRG by assessing the impact of all relevant secondary diagnoses

The MS-DRG system assumes that the medical intervention/procedure will remain in the same body system (MDC) as the principal diagnosis. However, sometimes the principal procedure is not related to the principal diagnoses because it is associated with a different MDC/body system, which requires additional steps to determine the applicable MS-DRG.

• Turn to the “DRGs Associated with All MDCs” chapter in the  DRG Expert
• Scan the procedure codes listed under DRG 984 Prostatic O.R. Procedure Unrelated to PDX for the procedure code associated with your case. These are codes that range from 60.0 to 60.99 within ICD-9-CM Vol. 3
• If the applicable code is found under DRG 984 then the case will fall within a DRG referred to as a “triplet” where either a CC or a MCC can “move” the DRG
• Check the remaining diagnoses codes to see if any are classified as a CC or MCC and finalize the DRG based on the value of the applicable secondary diagnoses resulting in a DRG between 984 and 986

For example, a principal diagnosis of pneumonia would lead to a base medical MS-DRG in the respiratory system MDC. A transurethral resection of the prostate (TURP) procedure is found within the numeric index to procedures, but none of its associated MS-DRGs are located within the respiratory body system. There is a mismatch between the body system of the principal diagnosis and those associated with the procedure. A scan of the procedure codes listed under MS-DRG 984 locates the applicable procedure code. The final MS-DRG assignment depends on the presence or absence of secondary diagnoses classified as a CC or MCC.

If the procedure code is not found under DRG 984, scan the list under DRG 987 Nonextensive O.R. Procedure Unrelated to PDX for the applicable procedure code. These codes span several pages within the  DRG Expert . If the code is found, determine the impact of the secondary diagnoses to assign the working MS-DRG.

When the procedure code isn’t listed in the procedure indexes or the MDC didn’t match that of the principal diagnosis and was not listed under DRG 984 or DRG 987—then the assumption is the case belongs in DRGs 981-983. Assess the impact of secondary diagnoses to assign the working MS-DRG.

This final step requires a leap of faith, since it is based on a process of elimination where this is the “last resort” for DRG assignment. These DRGs are heavily scrutinized by auditors, as assignment within these DRGs can erroneously inflate reimbursement if the case is improperly assigned. Although some organizations try to avoid the reporting of DRGs 981-983, it can be an accurate MS-DRG assignment as long as the documentation supports the assignment of the principal diagnosis.

Editor’s Note : Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, CDI Education Director for HCPro Inc. and Associate Director of ACDIS for Education, answered this question. Contact her at  [email protected] . For information regarding CDI Boot Camps offered by HCPro visit  www.hcprobootcamps.com/courses/10040/overview .

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