FY2027 · MS-DRG v44 · live engine
Glass-box grouping.
Checked against the CMS Web Pricer.
The grouping and pricing engine behind this site runs the FY2027 inpatient formulas (FY2026 for discharges before October 1, 2026): operating, capital, IME, DSH, uncompensated care and outliers, with each hospital's own factors. It checks itself against the official Medicare pricer on demand. Not modeled yet: new-technology add-on payments on FY2026 discharges, the hospital-specific rate for sole community and Medicare-dependent hospitals, and cost-report settlement.
- 5,000 of 5,000 claims within $1.00 of the CMS Web Pricer, largest gap $0.22
- FHIR R4 · vendor · Epic Tapestry claim shapes
- 11 grouper manuals · FY2022–FY2027
System workflows
Live grouper
Active diagnosis array
CASE-7731| Code | Level | Description |
|---|---|---|
| A41.9 | Principal | Sepsis, unspecified organism |
| J98.11 | CC | Atelectasis |
| J96.01 | Not coded | Acute respiratory failure with hypoxiaDocumented, not coded |
Grouped and priced · real FY2027 output
MS-DRG
Septicemia or Severe Sepsis without MV >96 Hours without MCC
Total Medicare payment
Houston Methodist Hospital · CCN 450358
- FY2027 relative weight
- 1.0066
- Geometric mean LOS
- 3.4 days
Grouping path
- Principal diagnosisA41.9Sepsis, unspecified organism
- Major diagnostic categoryMDC 18Infectious & Parasitic Diseases, Systemic or Unspecified Sites
- PartitionMedicalno OR procedure
- Base DRGs870–872
- SeverityCCset by J98.11
- MS-DRG872Septicemia or Severe Sepsis without MV >96 Hours without MCC
CDI audit
Documentation scan · H&P
- Documented, not coded
J96.01(MCC) appears in the note but not on the claim.Patient is a 68-year-old male presenting to the ED with fever, chills, and productive cough. Vitals show T 102.4, HR 115, BP 90/60. Labs indicate elevated WBC and lactate. Patient is currently experiencing acute hypoxemic respiratory failure (documented, not on the claim) requiring supplemental oxygen and escalation of respiratory support. Initiating broad-spectrum IV antibiotics for presumed sepsis. Chest imaging shows basilar atelectasis.
MS-DRG assignment
| As first coded | MS-DRG 872 | $12,224.90 |
|---|---|---|
| Coded to the note | MS-DRG 871 | $21,591.04 |
Surfaces conditions already documented by the physician. Documentation completeness — never severity inflation.
FHIR API
/api/v1/drg/group200 OK// FHIR R4 Claim in — format auto-detected (native / vendor / Tapestry too) { "resourceType": "Claim", "provider": { "identifier": { "value": "450358" } }, "diagnosis": [ { "sequence": 1, "code": "A41.9" }, { "sequence": 2, "code": "J98.11" }, { "sequence": 3, "code": "J96.01" } ] } // grouped + priced in one pass (trimmed) { "grouper": { "drg": "871", "severity": "MCC", "severityDriver": "J9601", "grouperVersion": "v44", "path": "medical" }, "drgTitle": "Septicemia or Severe Sepsis w/o MV >96 Hours with MCC", "pricing": { "fiscalYear": 2027, "grandTotal": 21591.04 } }
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