Key facts for DRG 804
- FY2027 relative weight
- 1.4220
- Higher than 40% of all MS-DRGs
- Change vs FY2026
- +4.9%
- FY2026 weight 1.3560
- Geometric mean LOS
- 1.7 days
- Arithmetic mean 2.5 days
- MDC
- 16
- Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders
- Severity level
- without CC or MCC
- Transfer policy
- Not a transfer DRG
TL;DR
MS-DRG 804 is a surgical group in MDC 16 (Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders) at the base severity level of its family. CMS assigns it a FY2027 relative weight of 1.4220 with a geometric mean length of stay of 1.7 days and an arithmetic mean of 2.5. Its weight moved up 4.9% from FY2026 (1.3560). That weight is higher than 40% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 802, DRG 803) spans weights 1.4220 to 3.7000. The v44 Definitions Manual assigns it through 1565 operating room procedures codes.
What changed from FY2026 to FY2027
CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 804 the FY2027 relative weight is 1.4220 against 1.3560 in FY2026, a rise of 4.87%, which exceeds the 2% threshold worth re-checking in contract models.
| Metric | FY2026 | FY2027 | Change |
|---|---|---|---|
| Relative weight | 1.3560 | 1.4220 | +0.0660 |
| Geometric mean LOS (days) | 1.7 | 1.7 | +0.0 |
| Arithmetic mean LOS (days) | 2.2 | 2.5 | +0.3 |
CC and MCC family
DRG 804 shares its base definition with 2 other MS-DRGs split by severity. The family's weights span 1.4220 to 3.7000, a 2.60× spread, which is the payment effect of documenting qualifying complications and comorbidities.
| DRG | Title | FY2027 weight | GMLOS |
|---|---|---|---|
| 802 | Other O.R. Procedures of the Blood and Blood Forming Organs with MCC | 3.7000 | 7.7 |
| 803 | Other O.R. Procedures of the Blood and Blood Forming Organs with CC | 1.9780 | 3.8 |
| 804 | Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC | 1.4220 | 1.7 |
Grouper logic (v44 Definitions Manual)
Operating Room Procedures: 1565 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 02HV02Z | Insertion of Monitoring Device into Superior Vena Cava, Open Approach |
| 02HV0DZ | Insertion of Intraluminal Device into Superior Vena Cava, Open Approach |
| 02HV3DZ | Insertion of Intraluminal Device into Superior Vena Cava, Percutaneous Approach |
| 02HV42Z | Insertion of Monitoring Device into Superior Vena Cava, Percutaneous Endoscopic Approach |
| 02HV4DZ | Insertion of Intraluminal Device into Superior Vena Cava, Percutaneous Endoscopic Approach |
| 02JA4ZZ | Inspection of Heart, Percutaneous Endoscopic Approach |
| 02JY4ZZ | Inspection of Great Vessel, Percutaneous Endoscopic Approach |
| 02LV0CZ | Occlusion of Superior Vena Cava with Extraluminal Device, Open Approach |
| 02LV0DZ | Occlusion of Superior Vena Cava with Intraluminal Device, Open Approach |
| 02LV0ZZ | Occlusion of Superior Vena Cava, Open Approach |
| 02LV3CZ | Occlusion of Superior Vena Cava with Extraluminal Device, Percutaneous Approach |
| 02LV3DZ | Occlusion of Superior Vena Cava with Intraluminal Device, Percutaneous Approach |
Documentation and denial exposure
As a surgical DRG, assignment depends on a qualifying operating-room procedure being coded from the operative report; a missing or non-OR procedure code drops the stay into a medical DRG in MDC 16 with a lower weight. Because this family splits by severity, auditors target CC and MCC capture: each secondary diagnosis must be documented as present, monitored, evaluated or treated during the stay to survive a DRG-validation review. Typical inpatient denial codes for this group: CARC 16 (claim lacks information needed to group the stay), CARC 50 (the admission or procedure is judged not medically necessary), CARC 97 (a service is bundled into the DRG payment).
How QuickIntell uses DRG 804 data
QuickCode groups inpatient encounters against the current v44 logic, flags CC and MCC candidates that lack supporting documentation, and shows the weight difference across the family before the claim drops. QuickScribe captures the attending's language that supports severity, and QuickRCM works DRG-validation denials with the grouper evidence attached.
Frequently asked questions — DRG 804
What is MS-DRG 804?
MS-DRG 804 is "Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC", a surgical Medicare Severity Diagnosis-Related Group in MDC 16, Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders. Medicare pays inpatient stays grouped here at the hospital's base rate multiplied by the DRG relative weight.
What is the FY2027 relative weight for DRG 804?
The FY2027 relative weight is 1.4220 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 1.3560, a change of +4.9%.
What is the average length of stay for DRG 804?
CMS reports a geometric mean length of stay of 1.7 days and an arithmetic mean of 2.5 days for FY2027. The geometric mean is used for transfer-payment calculations.
Which DRGs are in the same CC/MCC family as 804?
DRG 802 (Other O.R. Procedures of the Blood and Blood Forming Organs with MCC, weight 3.7000); DRG 803 (Other O.R. Procedures of the Blood and Blood Forming Organs with CC, weight 1.9780). The family's weights range from 1.4220 to 3.7000, so documented complications and comorbidities change payment materially.
What documentation supports the severity level of DRG 804?
DRG 804 is the base-severity assignment: no secondary diagnosis on the CC or MCC lists was coded, or the only ones present are excluded for this principal diagnosis. Revenue-integrity review here looks for undercapture, meaning conditions treated during the stay (electrolyte disorders, specified anemia, acute blood loss, pressure injuries present on admission) that were never documented to the specificity the lists require. A compliant query to the attending, not a coder assumption, is the only way to move a stay to the CC or MCC sibling.
Which codes group to DRG 804?
The v44 Definitions Manual lists 1565 operating room procedures codes for this group. Examples from the operating room procedures list: 02HV02Z (Insertion of Monitoring Device into Superior Vena Cava, Open Approach); 02HV0DZ (Insertion of Intraluminal Device into Superior Vena Cava, Open Approach); 02HV3DZ (Insertion of Intraluminal Device into Superior Vena Cava, Percutaneous Approach); 02HV42Z (Insertion of Monitoring Device into Superior Vena Cava, Percutaneous Endoscopic Approach).
Is DRG 804 a post-acute transfer DRG?
No. DRG 804 is not on the FY2027 post-acute care transfer list, so the transfer per-diem policy does not apply to it.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.
- IPPS FY2027 Final Rule Table 5 (CMS-1849-F)Version v44 FY2027 · effective 2026-10-01 · file CMS-1849-F Table 5.txtSHA-256 01003dd571c1e2f5…
- IPPS FY2026 Final Rule Table 5 (CMS-1833-F)Version v43 FY2026 · effective 2025-10-01 · file CMS-1833-F Table 5.txtSHA-256 bf8c390d14b3cd3e…
- ICD-10 MS-DRG Definitions Manual v44 (text)Version v44 · effective 2026-10-01 · file fy2027-fr-icd10-ms-drg-definitions-manual-files-v44.zipSHA-256 ae4f6c11727fe91f…
Disclaimer
This page is an operational reference compiled from the CMS IPPS FY2027 final rule (Table 5) and the v44 ICD-10 MS-DRG Definitions Manual. Relative weights are national factors; actual payment depends on each hospital's wage-adjusted base rate, add-ons, outliers and transfer adjustments. Nothing here is legal, clinical or billing advice; verify grouping against your encoder and the published CMS files.