Interstitial Lung Disease with MCC
Major Diagnostic Category 04·Grouped by diagnosis·FY 2027
MS-DRG 196 is a Medical Medicare Severity Diagnosis Related Group under Major Diagnostic Category 04 (MDC 04) with a Major Complication or Comorbidity (MCC). It maps to 100 ICD-10-CM diagnosis codes. For FY 2027 it carries a relative weight of 1.8336 with a geometric mean length of stay of 4.8 days and an arithmetic mean of 6.4 days. Hospitals use this grouping to determine reimbursement for inpatient stays under Medicare.
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FY 2027 payment data
From Table 5 of the FY 2027 IPPS Final Rule (CMS).
- Relative weight:
- 1.8336 (payment multiplier vs. the average case (1.0))
- Geometric mean stay:
- 4.8 days (used for transfer payments)
- Average stay:
- 6.4 days (arithmetic mean)
- Post-acute transfer policy:
- Yes (early transfers can be paid less)
Same condition, other severity levels
CMS splits one condition into separate DRGs by how sick the patient is. With MCC pays more than with CC, which pays more than without CC/MCC.
Diagnosis codes (100)
As the principal diagnosis, these ICD-10-CM codes can group to DRG 196. 100% of the codes listed are billable.
- B44.81Allergic bronchopulmonary aspergillosis
- B90.9Sequelae of respiratory and unspecified tuberculosis
- D86.0Sarcoidosis of lung
- D86.1Sarcoidosis of lymph nodes
- D86.2Sarcoidosis of lung with sarcoidosis of lymph nodes
- D86.3Sarcoidosis of skin
- D86.81Sarcoid meningitis
- D86.82Multiple cranial nerve palsies in sarcoidosis
- D86.83Sarcoid iridocyclitis
- D86.84Sarcoid pyelonephritis
- D86.85Sarcoid myocarditis
- D86.86Sarcoid arthropathy
- D86.87Sarcoid myositis
- D86.89Sarcoidosis of other sites
- D86.9Sarcoidosis, unspecified
- J60Coalworker's pneumoconiosis
- J61Pneumoconiosis due to asbestos and other mineral fibers
- J62.0Pneumoconiosis due to talc dust
- J62.8Pneumoconiosis due to other dust containing silica
- J63.0Aluminosis (of lung)
- J63.1Bauxite fibrosis (of lung)
- J63.2Berylliosis
- J63.3Graphite fibrosis (of lung)
- J63.4Siderosis
- J63.5Stannosis
- J63.6Pneumoconiosis due to other specified inorganic dusts
- J64Unspecified pneumoconiosis
- J65Pneumoconiosis associated with tuberculosis
- J66.0Byssinosis
- J66.1Flax-dressers' disease
- J66.2Cannabinosis
- J66.8Airway disease due to other specific organic dusts
- J67.0Farmer's lung
- J67.1Bagassosis
- J67.2Bird fancier's lung
- J67.3Suberosis
- J67.4Maltworker's lung
- J67.5Mushroom-worker's lung
- J67.6Maple-bark-stripper's lung
- J67.7Air conditioner and humidifier lung
- J67.8Hypersensitivity pneumonitis due to other organic dusts
- J67.9Hypersensitivity pneumonitis due to unspecified organic dust
- J70.1Chronic and other pulmonary manifestations due to radiation
- J82.81Chronic eosinophilic pneumonia
- J82.82Acute eosinophilic pneumonia
- J82.83Eosinophilic asthma
- J82.89Other pulmonary eosinophilia, not elsewhere classified
- J84.01Alveolar proteinosis
- J84.02Pulmonary alveolar microlithiasis
- J84.03Idiopathic pulmonary hemosiderosis
- J84.09Other alveolar and parieto-alveolar conditions
- J84.10Pulmonary fibrosis, unspecified
- J84.111Idiopathic interstitial pneumonia, not otherwise specified
- J84.112Idiopathic pulmonary fibrosis
- J84.113Idiopathic non-specific interstitial pneumonitis
- J84.114Acute interstitial pneumonitis
- J84.115Respiratory bronchiolitis interstitial lung disease
- J84.116Cryptogenic organizing pneumonia
- J84.117Desquamative interstitial pneumonia
- J84.170Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere
- J84.178Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere
- J84.2Lymphoid interstitial pneumonia
- J84.81Lymphangioleiomyomatosis
- J84.82Adult pulmonary Langerhans cell histiocytosis
- J84.83Surfactant mutations of the lung
- J84.841Neuroendocrine cell hyperplasia of infancy
- J84.842Pulmonary interstitial glycogenosis
- J84.843Alveolar capillary dysplasia with vein misalignment
- J84.848Other interstitial lung diseases of childhood
- J84.89Other specified interstitial pulmonary diseases
- J84.9Interstitial pulmonary disease, unspecified
- J99Respiratory disorders in diseases classified elsewhere
- M05.10Rheumatoid lung disease with rheumatoid arthritis of unspecified site
- M05.111Rheumatoid lung disease with rheumatoid arthritis of right shoulder
- M05.112Rheumatoid lung disease with rheumatoid arthritis of left shoulder
- M05.119Rheumatoid lung disease with rheumatoid arthritis of unspecified shoulder
- M05.121Rheumatoid lung disease with rheumatoid arthritis of right elbow
- M05.122Rheumatoid lung disease with rheumatoid arthritis of left elbow
- M05.129Rheumatoid lung disease with rheumatoid arthritis of unspecified elbow
- M05.131Rheumatoid lung disease with rheumatoid arthritis of right wrist
- M05.132Rheumatoid lung disease with rheumatoid arthritis of left wrist
- M05.139Rheumatoid lung disease with rheumatoid arthritis of unspecified wrist
- M05.141Rheumatoid lung disease with rheumatoid arthritis of right hand
- M05.142Rheumatoid lung disease with rheumatoid arthritis of left hand
- M05.149Rheumatoid lung disease with rheumatoid arthritis of unspecified hand
- M05.151Rheumatoid lung disease with rheumatoid arthritis of right hip
- M05.152Rheumatoid lung disease with rheumatoid arthritis of left hip
- M05.159Rheumatoid lung disease with rheumatoid arthritis of unspecified hip
- M05.161Rheumatoid lung disease with rheumatoid arthritis of right knee
- M05.162Rheumatoid lung disease with rheumatoid arthritis of left knee
- M05.169Rheumatoid lung disease with rheumatoid arthritis of unspecified knee
- M05.171Rheumatoid lung disease with rheumatoid arthritis of right ankle and foot
- M05.172Rheumatoid lung disease with rheumatoid arthritis of left ankle and foot
- M05.179Rheumatoid lung disease with rheumatoid arthritis of unspecified ankle and foot
- M05.19Rheumatoid lung disease with rheumatoid arthritis of multiple sites
- M34.81Systemic sclerosis with lung involvement
- P27.0Wilson-Mikity syndrome
- P27.1Bronchopulmonary dysplasia originating in the perinatal period
- P27.8Other chronic respiratory diseases originating in the perinatal period
- P27.9Unspecified chronic respiratory disease originating in the perinatal period
