PDX/SDX Analysis | DRG Weight & GMLOS | Real Hospital Cases | AAPC-Aligned Curriculum
Why IP-DRG Coding is the Highest-Paying Medical Coding Specialty
IP-DRG (Inpatient Diagnosis-Related Group) coding is the most complex and lucrative field in medical coding. Hospitals, insurance companies, and healthcare analytics firms urgently need certified IP-DRG coders who can accurately group inpatient cases, optimize reimbursements, and ensure compliance. With Prohealth Academy's training, you'll command salaries 40% higher than outpatient coders.
What You'll Learn: End-to-End IP-DRG Mastery
15 Modules | 100+ Real Cases | 50+ Coding Scenarios
• DRG system history (US Medicare & Indian IR-DRG)
• Relative Weight (RW), GMLOS, AMLOS calculations
• DRG Grouper software navigation
• MDC (Major Diagnostic Categories) overview
• Patient Scenario: 45-year-old male admitted for acute MI, chest pain, diabetes. Learn initial PDX identification.
• UHDDS definition of PDX
• Two or more interrelated conditions
• Symptom vs. definitive diagnosis
• PDX exceptions (complications, obstetrics, injuries)
• Coding Scenario: Sepsis due to UTI with E. coli – which is PDX
• CC (Complication/Comorbidity) vs. MCC (Major CC)
• Impact on DRG weight and reimbursement
• POA (Present on Admission) indicators
• Hospital Case: Pneumonia with acute respiratory failure, CKD stage 3 – identify CC/MCC.
• How RW affects hospital payment
• GMLOS vs. actual length of stay
• Cost-outlier calculations
• Table Reference: Top 20 DRGs by volume & payment (Indian hospital data)
• OR procedures vs. non-OR procedures
• Pre-MDC DRGs (transplants, trachs)
• Scenario: Laparoscopic cholecystectomy vs. medical management of cholecystitis
Special Populations & Exceptions
• Obstetrics DRGs (normal delivery, C-section)
• Neonates & premature infants
• HIV/AIDS DRGs
• Case Study: Pre-eclampsia with severe features – DRG assignment.
Common IP-DRG Errors & Denials
• Incorrect PDX leading to DRG shift
• Missing CC/MCC documentation
• Query best practices
• Denial Management: How to appeal DRG downgrades.
Live Hospital Project
• Work on 50 real inpatient records from multispecialty hospitals
• Manual DRG grouping practice
• Present your findings to industry experts
• Get experience letter for your resume
Real Hospital Cases You'll Code During Training
Case 1
Acute Myocardial Infarction with PCI
Patient: 58-year-old female, STEMI anterior wall, PCI with drug-eluting stent, history of hypertension, Type 2 diabetes with neuropathy.
Task: Identify PDX, SDX, CC/MCC, assign DRG, calculate RW.
Case 2
Pneumonia with Sepsis & Mechanical Ventilation
Patient: 72-year-old male, community-acquired pneumonia, progresses to severe sepsis with acute kidney injury. Mechanical ventilation for 3 days.
Task: Determine principal diagnosis, validate POA indicators, assign correct MCC DRG.
Case 3
Postoperative Wound Dehiscence
Patient: 45-year-old female, s/p TAH-BSO, develops wound dehiscence and requires reoperation.
Task: Identify complication vs. principal diagnosis rules, assign surgical DRG.