Table 4.
Top 25 Professional Fee Ratios by Diagnostic Related Group and Payer Type for Inpatient Admissions, 2016–2020
| Rank | Commercial | Medicaid | ||||
|---|---|---|---|---|---|---|
| DRG code | DRG description | PFR | DRG code | DRG description | PFR | |
| 1 | 583 | MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC | 1.803 | 785 | CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC | 1.575 |
| 2 | 582 | MASTECTOMY FOR MALIGNANCY WITH CC/MCC | 1.757 | 798 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC | 1.499 |
| 3 | 581 | OTHER SKIN SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC | 1.639 | 807 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | 1.477 |
| 4 | 585 | BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC | 1.600 | 784 | CESAREAN SECTION WITH STERILIZATION WITH CC | 1.475 |
| 5 | 775 | VAGINAL DELIVERY WITHOUT COMPLICATING DIAGNOSES | 1.565 | 806 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC | 1.449 |
| 6 | 584 | BREAST BIOPSY LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC | 1.556 | 797 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC | 1.445 |
| 7 | 807 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC | 1.533 | 775 | VAGINAL DELIVERY WITHOUT COMPLICATING DIAGNOSES | 1.440 |
| 8 | 774 | VAGINAL DELIVERY WITH COMPLICATING DIAGNOSES | 1.506 | 783 | CESAREAN SECTION WITH STERILIZATION WITH MCC | 1.428 |
| 9 | 806 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC | 1.499 | 805 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC | 1.419 |
| 10 | 767 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C | 1.484 | 768 | VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C | 1.411 |
| 11 | 30 | SPINAL PROCEDURES WITHOUT CC/MCC | 1.483 | 789 | NEONATES DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY | 1.401 |
| 12 | 798 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC | 1.478 | 774 | VAGINAL DELIVERY WITH COMPLICATING DIAGNOSES | 1.395 |
| 13 | 805 | VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC | 1.475 | 788 | CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC | 1.395 |
| 14 | 766 | CESAREAN SECTION WITHOUT CC/MCC | 1.469 | 767 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C | 1.394 |
| 15 | 578 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC | 1.466 | 796 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC | 1.377 |
| 16 | 768 | VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C | 1.458 | 787 | CESAREAN SECTION WITHOUT STERILIZATION WITH CC | 1.370 |
| 17 | 797 | VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC | 1.440 | 998 | PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS | 1.368 |
| 18 | 785 | CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC | 1.439 | 766 | CESAREAN SECTION WITHOUT CC/MCC | 1.343 |
| 19 | 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | 1.434 | 786 | CESAREAN SECTION WITHOUT STERILIZATION WITH MCC | 1.334 |
| 20 | 577 | SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC | 1.434 | 534 | FRACTURES OF FEMUR WITHOUT MCC | 1.331 |
| 21 | 472 | CERVICAL SPINAL FUSION WITH CC | 1.429 | 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | 1.329 |
| 22 | 765 | CESAREAN SECTION WITH CC/MCC | 1.421 | 999 | UNGROUPABLE | 1.324 |
| 23 | 788 | CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC | 1.416 | 765 | CESAREAN SECTION WITH CC/MCC | 1.311 |
| 25 | 998 | PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS | 1.405 | 472 | CERVICAL SPINAL FUSION WITH CC | 1.291 |
| 25 | 784 | CESAREAN SECTION WITH STERILIZATION WITH CC | 1.398 | 455 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | 1.280 |
Data source: 2016–2020 Merative™ MarketScan® databases.
a
Counts for admissions and visits analyzed to produce these estimates and 95% confidence intervals reported in SDC1. DRG indicates Diagnostic Related Group; PFR Professional fee ratio.