MS-DRG grouper, group and price, and CDI assist

Independent pricing tool. Not affiliated with, endorsed by, or operated by CMS or any government agency. Estimates are not a claims determination.

Claim

Mode

Codes

Principal diagnosis
Secondary diagnoses
Procedures (ICD-10-PCS)

Patient and stay

Hospital and charges

Import a claim JSON

Four shapes convert in your browser: native (diagnoses, procedures, age, sex, dischargeStatus), a vendor PatientClaim/Dx claim, a FHIR R4 Claim resource, and an Epic Tapestry-style claim.

Coded diagnoses

Secondary diagnoses

Clinical note

Sample note

Ask AI is opt-in: it sends this note to the server for one model scan, and every code it proposes is checked against the ICD-10-CM and CC/MCC tables. The rule-based scan runs in this page and matches named conditions only. Note text is never put in links or saved in this browser.

Result

Sample result for the example claim (sepsis with septic shock), saved from the grouper. Change the codes and press Group to group your own.
Grouping path
    DRG family

    Codes that drive the DRG

    CodeDescriptionPOALevelEffect on the DRG

    How the payment builds

    ComponentAmount
    Open the full price build in the IPPS workbench
    Grouper response (raw)
    Saved example. The suggestions below are a model scan of the sample note captured earlier and shipped with this page. Nothing ran just now. Press Ask AI to scan live, or Scan note (rule-based).
    Current MS-DRG for the coded diagnoses
      Possible documentation gaps for provider clarification
      Impact if documented and clinically supported
      How the grouping would change if the provider documented the condition, it is clinically supported, and it were coded. Shown so coders understand the grouping, not to decide what to query: queries follow the clinical evidence in the record.
      Checks
      Validation edits
      Grouper notes
      How suggestions are made
      Rule-based
      Matches named conditions (for example "acute kidney injury") against a fixed list of common documentation gaps. Runs in this page. Not AI.
      AI-assisted
      Only when you press Ask AI. A model reads the note, including findings such as lab values, and proposes conditions. Every code is checked against the ICD-10-CM and CC/MCC tables, and codes already coded are dropped.
      Saved example
      A model scan of the sample note captured earlier and shipped with the page, so you can see the output without running anything.
      Documentation integrity
      Each item is a possible documentation gap for the provider to clarify, with the note text that prompted it. Code only what the provider documents and the record clinically supports. Provider queries copied from this page are open-ended, offer other answers, and never mention payment or the DRG.
      How MS-DRG grouping works
      The grouper assigns the principal diagnosis to a major diagnostic category, takes the surgical path when an operating-room procedure is present, and then sets the severity level from the secondary diagnoses that count as a complication or comorbidity (CC) or a major one (MCC), after CC exclusions and present-on-admission rules.
      The result shows the path step by step, which code set the severity, the relative weight and the other DRGs in the family. Group and price adds a hospital so the DRG is priced on the same engine as the IPPS workbench. CDI assist highlights conditions documented in a note but missing from the coded diagnoses, for provider clarification.
      Questions
      Which grouper version is used?
      The MS-DRG version in force for the discharge, selectable on the page.
      Does CDI assist suggest codes to raise payment?
      No. It lists conditions documented in the note but not coded, each with its evidence, for provider clarification. Code only what the record supports.
      Is grouping free?
      Yes. Grouping is free; pricing follows the free-tier DRG list and daily limit.