DRG Grouper API for Developers

Get Started in Minutes

Request

curl -X POST https://api.revenuecycle.works/api/drg/group \
  -H "X-API-Key: your_api_key_here" \
  -H "Content-Type: application/json" \
  -d '{
    "grouperVersion": "430",
    "principalDiagnosis": {
      "code": "I2510",
      "poa": "Y"
    },
    "secondaryDiagnoses": [
      {"code": "E119", "poa": "Y"},
      {"code": "I10", "poa": "Y"}
    ],
    "procedures": ["021109W"],
    "ageInYears": 65,
    "sex": "MALE",
    "dischargeStatus": "HOME_SELFCARE_ROUTINE"
  }'

Response

{
  "finalDrg": "236",
  "finalBaseDrg": "235",
  "finalMdc": "5",
  "finalSeverity": "NON_CC",
  "finalGrouperReturnCode": "OK",
  "diagnosisValidation": {
    "E119": true,
    "I2510": true,
    "I10": true
  },
  "procedureValidation": {
    "021109W": true
  },
  "diagnosisSeverityFlags": {
    "E119": "NEITHER",
    "I2510": "NEITHER",
    "I10": "NEITHER"
  },
  "diagnosisAffectsDrg": {
    "E119": false,
    "I2510": true,
    "I10": false
  },
  "procedureAffectsDrg": {
    "021109W": true
  },
  "procedureIsOperatingRoom": {
    "021109W": true
  },
  "hacStatus": "NOT_APPLICABLE"
}

Why Choose Our API

✓

Multiple MS-DRG Versions

Support for versions 40.0 through 43.0 (FY2024-FY2026), with automatic updates for new fiscal years

⚡

Sub-Second Response Times

Average API response time under 200ms for fast, real-time integrations

🔍

Complete ICD-10 Validation

Built-in validation for diagnosis and procedure codes with detailed error messages

🏥

HAC & POA Logic

Hospital-Acquired Condition detection and Present on Admission indicator processing

📋

MCE Validation

Medicare Code Editor validation including age/sex conflicts and discharge status edits

🔒

99.9%+ Uptime

Production-grade infrastructure with high availability and reliability

Built for Healthcare Technology

EHR/EMR Integration

Pre-populate expected reimbursement amounts and validate coding accuracy before claim submission. Help providers understand financial impact during the care delivery process.

Revenue Cycle Management

Validate claims before submission, identify coding errors early, and optimize reimbursement. Reduce claim denials with pre-submission validation.

Healthcare Analytics

Analyze case mix, track trends, and generate reports on DRG distribution. Build dashboards and business intelligence tools for healthcare organizations.

Clinical Decision Support

Show financial impact of diagnosis and procedure selection in real-time. Help clinicians make informed decisions about documentation and coding.

How It Works

Request API Access

Fill out our contact form with your use case and estimated volume. We'll discuss pricing options and get you set up with an API key.

Integrate with Your App

Use our comprehensive documentation and code examples to integrate in minutes. Support for Python, JavaScript, Ruby, PHP, and more.

Start Grouping

Send patient demographics and ICD-10 codes, receive instant DRG assignments with validation. Start building with full access to all features.

Trusted by Healthcare Organizations

99.9%

API Uptime

<200ms

Avg Response Time

MS-DRG Versions

" Powered by CMS-certified MS-DRG grouper software with the same logic used by Medicare Administrative Contractors. Maintained and updated annually with new fiscal year releases. "

Ready to Integrate?

Get your API key and start building today with full access to all features.

Request API Access View Documentation

Questions? Email us at [email protected]

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