Certified Coding Specialist (CCS) Practice Exam 2025 – Comprehensive All-in-One Guide to Achieve Exam Success!

Diagnostic-related groups (DRGs) are a system used to classify hospital cases into groups that are expected to have similar hospital resource use. Each DRG corresponds to a specific diagnosis and reflects the average cost associated with treating patients with that diagnosis, which helps in determining payment to hospitals under Medicare and other health insurance plans.

In this context, inpatient services are included in DRGs since they directly relate to the hospital stay and the procedures performed during that time. Similarly, many post-surgical care services are also accounted for under DRGs as they often occur concurrently with the inpatient service delivery for surgical patients. Outpatient procedures, on the other hand, can sometimes be captured by DRG assignments if they are closely related to inpatient stays or specific diagnoses.

Medical supplies, however, do not fall within the scope of DRGs because they are generally categorized separately. While they may be a necessary part of inpatient care, they are often billed separately outside of the DRG payment system. This distinction is why medical supplies are not typically included in the description of services encompassed by DRGs. Understanding this separation is critical for coding specialists as they navigate the complexities of billing and reimbursement.