Simple Pneumonia and Pleurisy without CC/MCC: Inpatient Reimbursement Overview
DRG 195 pertains to hospital stays for simple pneumonia and pleurisy without Complication or Comorbidity or Major Complication or Comorbidity and defines the clinical scope for uncomplicated respiratory infection admissions. This grouping matters for inpatient reimbursement because it determines the Centers for Medicare & Medicaid Services payment weight applied to such cases and influences hospital billing and resource allocation.
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DRG 195 Overview
DRG 195 covers hospital admissions for simple pneumonia and pleurisy without a Complication or Comorbidity or Major Complication or Comorbidity. This Diagnosis-Related Group applies when patients receive inpatient care for uncomplicated lower respiratory infections that do not trigger higher-severity groupings. It matters for Centers for Medicare & Medicaid Services payment because it establishes the base Medicare inpatient reimbursement rate for these straightforward pneumonia admissions. Hospitals use this grouping to classify cases that typically require medical management without intensive resource use.