In the scenario of a patient with pneumonia and diabetes, the final DRG is stated to be which value?

• A. 194
• B. 195
• C. 196
• D. 197

Answer: (B)

The key idea is that DRG assignment depends on the principal diagnosis plus any coexisting conditions that raise resource use. Pneumonia drives one DRG category, but diabetes as a comorbidity adds medical complexity. In the DRG system, a comorbidity like diabetes is treated as a CC, and if it’s significant enough, as an MCC. When a pneumonia case has such a CC/MCC, it moves into the higher category within the pneumonia DRG group to reflect the greater expected needs, length of stay, and costs. So the final DRG is the higher category corresponding to pneumonia with a CC/MCC, rather than the lower category for pneumonia without that comorbidity. If diabetes weren’t present or wouldn’t be coded as a CC/MCC, the case would fall into the lower pneumonia DRG.