In relation to DRG assignment, which statement is correct?

• A. DRG grouping is random.
• B. DRG grouping pertains only to outpatient.
• C. DRG grouping for inpatient reimbursement is informed by UB-04 data.
• D. DRG grouping is determined by patient age.

Answer: (C)

DRG assignment for inpatient reimbursement uses standardized groupings based on coded clinical information from the patient’s inpatient record. In practice, the payer’s DRG grouper pulls data from the UB-04 claim—principal diagnosis, secondary diagnoses, procedure codes, discharge status, age/sex, and admission type—to determine the DRG category that best represents expected resource use. Therefore, the statement that inpatient DRG grouping is informed by UB-04 data is the correct one. The other statements aren’t correct because DRGs are not assigned randomly, they’re not limited to outpatient services (that’s a separate outpatient system with different payment rules), and age alone does not determine DRG classification—the grouping is driven by diagnoses and procedures.