DRG Expert a Comprehensive Guidebook to the MS-DRG Classification System

DRG Expert A comprehensive guidebook to the MS-DRG classification system

Changes effective with discharges on or after October 1, 2010

2011 27th Edition Contents

Numeric Listing of DRGs ...... i MDC 16 Diseases And Disorders Of The Blood And Blood-Forming Organs And DRG Listing by Major Diagnostic Category ...... xiii Immunological Disorders ...... 200 MDC 17 Myeloproliferative Diseases And Introduction ...... xxv Pre MDC ...... 1 Disorders And Poorly Differentiated Neoplasms ...... 203 MDC 1 Diseases And Disorders Of The Nervous System ...... 5 MDC 18 Infectious And Parasitic Diseases ...... 210 MDC 2 Diseases And Disorders Of The Eye ..... 39 MDC 19 Mental Diseases And Disorders ...... 214 MDC 3 Diseases And Disorders Of The Ear, MDC 20 Alcohol/Drug Use And Alcohol/ Nose, Mouth And Throat ...... 46 Drug- Induced Organic Mental Disorders ...... 217 MDC 4 Diseases And Disorders Of The Respiratory System ...... 55 MDC 21 Injury, Poisoning And Toxic Effects Of Drugs ...... 219 MDC 5 Diseases And Disorders Of The Circulatory System ...... 62 MDC 22 Burns ...... 234 MDC 6 Diseases And Disorders Of The MDC 23 Factors Influencing Health Status Digestive System ...... 79 And Other Contacts With Health Services ...... 240 MDC 7 Diseases And Disorders Of The Hepatobiliary System And Pancreas ..... 91 MDC 24 Multiple Significant Trauma ...... 245 MDC 8 Diseases And Disorders Of The MDC 25 Human Immunodeficiency Virus Musculoskeletal System And Infections ...... 260 Connective Tissue ...... 96 Alphabetic Index to Diseases ...... 269 MDC 9 Diseases And Disorders Of The Skin, Subcutaneous Tissue And Breast ...... 116 Numeric Index to Diseases ...... 337 MDC 10 Endocrine, Nutritional And Metabolic Diseases And Disorders ...... 125 Alphabetic Index to Procedures ...... 405 MDC 11 Diseases And Disorders Of The Kidney Numeric Index to Procedures ...... 427 And Urinary Tract ...... 131 MDC 12 Diseases And Disorders Of The Male Appendix A — Lists of CCs and MCCs ...... Appendix-1 Reproductive System ...... 138 MDC 13 Diseases And Disorders Of The Female Appendix B — List of Transfer and Reproductive System ...... 143 Special Payment DRGs ...... Appendix-125 MDC 14 Pregnancy, Childbirth And The Appendix C — MS-DRG Surgical Puerperium ...... 151 Hierarchy Table ...... Appendix-129 MDC 15 Newborns And Other Neonates With Conditions Originating In Appendix D — MS-LTC-DRG Crosswalk .Appendix-133 The Perinatal Period ...... 187 Appendix E — National Average Payment Table ...... Appendix-151 MDC 1 Diseases And Disorders Of The Nervous System

003.21 013.96 063.9 227.5 324.9 334.3 341.1 346.02 351.0 006.5 036.0 064 227.6 325 334.4 341.20 346.03 351.1 013.00 036.1 066.2 228.02 326 334.8 341.21 346.10 351.8 013.01 045.00 071 237.1 327.21 334.9 341.22 346.11 351.9 013.02 045.01 072.1 237.3 327.25 335.0 341.8 346.12 352.0 013.03 045.02 072.2 237.5 327.27 335.10 341.9 346.13 352.1 013.04 045.03 072.72 237.6 327.30 335.11 342.00 346.20 352.2 013.05 045.10 078.81 237.70 327.31 335.19 342.01 346.21 352.3 013.06 045.11 090.40 237.71 327.32 335.20 342.02 346.22 352.4 MDC 1: Diseases And Disorder 013.10 045.12 090.41 237.72 327.33 335.21 342.10 346.23 352.5 013.11 045.13 090.42 237.73 327.34 335.22 342.11 346.30 352.6 013.12 045.90 090.49 237.79 327.35 335.23 342.12 346.31 352.9 013.13 045.91 091.81 237.9 327.36 335.24 342.80 346.32 353.0 013.14 045.92 094.0 239.6 327.37 335.29 342.81 346.33 353.1 013.15 045.93 094.1 249.60 327.39 335.8 342.82 346.40 353.2 013.16 046.0 094.2 249.61 327.41 335.9 342.90 346.41 353.3 013.20 046.11 094.3 250.60 327.43 336.0 342.91 346.42 353.4 013.21 046.19 094.81 250.61 327.51 336.1 342.92 346.43 353.5 013.22 046.2 094.82 250.62 327.52 336.2 343.0 346.50 353.6 013.23 046.3 094.85 250.63 330.0 336.3 343.1 346.51 353.8 013.24 046.71 094.87 307.20 330.1 336.8 343.2 346.52 353.9 013.25 046.72 094.89 307.21 330.2 336.9 343.3 346.53 354.0 013.26 046.79 094.9 307.22 330.3 337.00 343.4 346.60 354.1 013.30 046.8 098.82 307.23 330.8 337.01 343.8 346.61 354.2 013.31 046.9 100.81 307.81 330.9 337.09 343.9 346.62 354.3 013.32 047.0 100.89 310.2 331.0 337.1 344.00 346.63 354.4 013.33 047.1 112.83 315.35 331.11 337.20 344.01 346.70 354.5 013.34 047.8 114.2 320.0 331.19 337.21 344.02 346.71 354.8 System—SURGICAL Nervous The Of s 013.35 047.9 115.01 320.1 331.2 337.22 344.03 346.72 354.9 013.36 048 115.11 320.2 331.3 337.29 344.04 346.73 355.0 013.40 049.0 115.91 320.3 331.4 337.3 344.09 346.80 355.1 013.41 049.1 130.0 320.7 331.5 337.9 344.1 346.81 355.2 013.42 049.8 137.1 320.81 331.7 338.0 344.2 346.82 355.3 013.43 049.9 138 320.82 331.81 338.21 344.30 346.83 355.4 013.44 052.0 139.0 320.89 331.82 338.22 344.31 346.90 355.5 013.45 052.2 191.0 320.9 331.83 338.28 344.32 346.91 355.6 013.46 053.0 191.1 321.0 331.89 338.29 344.40 346.92 355.71 013.50 053.10 191.2 321.1 331.9 338.4 344.41 346.93 355.79 013.51 053.11 191.3 321.2 332.0 339.00 344.42 347.00 355.8 013.52 053.12 191.4 321.3 332.1 339.01 344.5 347.01 355.9 013.53 053.13 191.5 321.4 333.0 339.02 344.60 347.10 356.0 013.54 053.14 191.6 321.8 333.1 339.03 344.81 347.11 356.1 013.55 053.19 191.7 322.0 333.2 339.04 344.89 348.0 356.2 013.56 054.3 191.8 322.1 333.3 339.05 344.9 348.1 356.3 013.60 054.72 191.9 322.2 333.4 339.09 345.00 348.2 356.4 013.61 054.74 192.0 322.9 333.5 339.10 345.01 348.30 356.8 013.62 055.0 192.1 323.01 333.6 339.11 345.10 348.31 356.9 013.63 056.00 192.2 323.02 333.71 339.12 345.11 348.39 357.0 013.64 056.01 192.3 323.1 333.72 339.20 345.2 348.4 357.1 013.65 056.09 192.8 323.2 333.79 339.21 345.3 348.5 357.2 013.66 058.21 192.9 323.41 333.82 339.22 345.40 348.81 357.3 013.80 058.29 194.4 323.42 333.83 339.3 345.41 348.89 357.4 013.81 062.0 194.5 323.51 333.84 339.41 345.50 348.9 357.5 013.82 062.1 194.6 323.52 333.85 339.42 345.51 349.0 357.6 013.83 062.2 198.3 323.61 333.89 339.43 345.60 349.1 357.7 013.84 062.3 198.4 323.62 333.90 339.44 345.61 349.2 357.81 013.85 062.4 225.0 323.63 333.91 339.81 345.70 349.81 357.82 013.86 062.5 225.1 323.71 333.92 339.82 345.71 349.82 357.89 013.90 062.8 225.2 323.72 333.93 339.83 345.80 349.89 357.9 013.91 062.9 225.3 323.81 333.94 339.84 345.81 349.9 358.00 013.92 063.0 225.4 323.82 333.99 339.85 345.90 350.1 358.01 013.93 063.1 225.8 323.9 334.0 339.89 345.91 350.2 358.1 013.94 063.2 225.9 324.0 334.1 340 346.00 350.8 358.2 013.95 063.8 227.4 324.1 334.2 341.0 346.01 350.9 358.8

44.66 Other procedures for creation of esophagogastric SURGICAL sphincteric competence 44.67 Laparoscopic procedures for creation of DRGy 326 Stomach, Esophageal and Duodenal Procedures esophagogastric sphincteric competence swith y MCC 44.68 Laparoscopic gastroplasty GMLOS 12.6 AMLOS 16.2 RW 5.8142 T 44.69 Other repair of stomach 44.91 Ligation of gastric varices Operating Room Procedures 44.92 Intraoperative manipulation of stomach 29.3* Excision or destruction of lesion or tissue of pharynx 44.99 Other operations on stomach 31.73 Closure of other fistula of trachea 45.01 Incision of duodenum 38.05 Incision of other thoracic vessels 45.31 Other local excision of lesion of duodenum 38.35 Resection of other thoracic vessels with anastomosis 45.32 Other destruction of lesion of duodenum 38.45 Resection of other thoracic vessels with replacement 46.71 Suture of laceration of duodenum 38.65 Other excision of other thoracic vessel 46.72 Closure of fistula of duodenum Disorders And Diseases 6: MDC 38.85 Other surgical occlusion of other thoracic vessel 51.82 Pancreatic sphincterotomy 39.1 Intra-abdominal venous shunt 51.83 Pancreatic sphincteroplasty 42.01 Incision of esophageal web 52.7 Radical pancreaticoduodenectomy 42.09 Other incision of esophagus 53.7* Repair of diaphragmatic hernia, abdominal approach 42.1* Esophagostomy 53.8* Repair of diaphragmatic hernia, thoracic approach 42.21 Operative esophagoscopy by incision 42.25 Open biopsy of esophagus DRGy 327 Stomach, Esophageal and Duodenal Procedures 42.31 Local excision of esophageal diverticulum swith y CC 42.32 Local excision of other lesion or tissue of esophagus GMLOS 6.9 AMLOS 8.8 RW 2.7231 T4 42.39 Other destruction of lesion or tissue of esophagus 42.4* Excision of esophagus Select operating room procedures listed under DRG 326 42.5* Intrathoracic anastomosis of esophagus 42.6* Antesternal anastomosis of esophagus DRGy 328 Stomach, Esophageal and Duodenal Procedures 42.7 Esophagomyotomy without CC/MCC 42.82 Suture of laceration of esophagus GMLOS 2.9 AMLOS 3.8 RW 1.4298 T4

42.83 Closure of esophagostomy Digestive System—SURGICAL Of The Select operating room procedures listed under DRG 326 42.84 Repair of esophageal fistula, not elsewhere classified 42.85 Repair of esophageal stricture 42.86 Production of subcutaneous tunnel without esophageal DRGy 329 Major Small and Large Bowel Procedures swithy y MCC anastomosis GMLOS 12.5 AMLOS 15.4 RW 5.2807 T4 42.87 Other graft of esophagus Operating Room Procedures 42.89 Other repair of esophagus 17.3* Laparoscopic partial excision of large intestine 42.91 Ligation of esophageal varices 45.5* Isolation of intestinal segment 43.0 Gastrotomy 45.6* Other excision of small intestine 43.3 Pyloromyotomy 45.7* Open and other partial excision of large intestine 43.42 Local excision of other lesion or tissue of stomach 45.8* Total intra-abdominal colectomy 43.49 Other destruction of lesion or tissue of stomach 45.9* Intestinal anastomosis 43.5 Partial gastrectomy with anastomosis to esophagus 46.0* Exteriorization of intestine 43.6 Partial gastrectomy with anastomosis to duodenum 46.10 Colostomy, not otherwise specified 43.7 Partial gastrectomy with anastomosis to jejunum 46.11 Temporary colostomy 43.8* Other partial gastrectomy 46.13 Permanent colostomy 43.9* Total gastrectomy 46.20 Ileostomy, not otherwise specified 44.0* Vagotomy 46.21 Temporary ileostomy 44.11 Transabdominal gastroscopy 46.22 Continent ileostomy 44.15 Open biopsy of stomach 46.23 Other permanent ileostomy 44.21 Dilation of pylorus by incision 46.73 Suture of laceration of small intestine, except 44.29 Other pyloroplasty duodenum 44.3* Gastroenterostomy without gastrectomy 46.74 Closure of fistula of small intestine, except duodenum 44.40 Suture of peptic ulcer, not otherwise specified 46.75 Suture of laceration of large intestine 44.41 Suture of gastric ulcer site 46.76 Closure of fistula of large intestine 44.42 Suture of duodenal ulcer site 46.79 Other repair of intestine 44.5 Revision of gastric anastomosis 46.80 Intra-abdominal manipulation of intestine, not 44.61 Suture of laceration of stomach otherwise specified 44.63 Closure of other gastric fistula 46.81 Intra-abdominal manipulation of small intestine 44.64 Gastropexy 46.82 Intra-abdominal manipulation of large intestine 44.65 Esophagogastroplasty 46.91 Myotomy of sigmoid colon 46.92 Myotomy of other parts of colon

Transfer DRGs 186 Pleural Effusion with MCC 187 Pleural Effusion with CC 003 ECMO or Tracheostomy with Mechanical Ventilation 188 Pleural Effusion without CC/MCC 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. 190 Chronic Obstructive Pulmonary Disease with MCC 004 Tracheostomy with Mechanical Ventilation 96+ Hours or 191 Chronic Obstructive Pulmonary Disease with CC Principal Diagnosis Except Face, Mouth and Neck 192 Chronic Obstructive Pulmonary Disease without without Major O.R. CC/MCC 025 Craniotomy and Endovascular Intracranial Procedures 193 Simple Pneumonia and Pleurisy with MCC with MCC 194 Simple Pneumonia and Pleurisy with CC 026 Craniotomy and Endovascular Intracranial Procedures 195 Simple Pneumonia and Pleurisy without CC/MCC with CC 196 Interstitial Lung Disease with MCC 027 Craniotomy and Endovascular Intracranial Procedures 197 Interstitial Lung Disease with CC without CC/MCC 198 Interstitial Lung Disease without CC/MCC 031 Ventricular Shunt Procedures with MCC 205 Other Respiratory System Diagnoses with MCC 032 Ventricular Shunt Procedures with CC 206 Other Respiratory System Diagnoses without MCC 033 Ventricular Shunt Procedures without CC/MCC 207 Respiratory System Diagnosis with Ventilator Support 054 Nervous System Neoplasms with MCC 96+ Hours Transfer B — Appendix DRGs 055 Nervous System Neoplasms without MCC 216 Cardiac Valve and Other Major Cardiothoracic 056 Degenerative Nervous System Disorders with MCC Procedures with Cardiac Catheterization with MCC 057 Degenerative Nervous System Disorders without MCC 217 Cardiac Valve and Other Major Cardiothoracic 064 Intracranial Hemorrhage or Cerebral Infarction with Procedures with Cardiac Catheterization with CC MCC 218 Cardiac Valve and Other Major Cardiothoracic 065 Intracranial Hemorrhage or Cerebral Infarction with CC Procedures with Cardiac Catheterization without 066 Intracranial Hemorrhage or Cerebral Infarction without CC/MCC CC/MCC 228 Other Cardiothoracic Procedures with MCC 070 Nonspecific Cerebrovascular Disorders with MCC 229 Other Cardiothoracic Procedures with CC 071 Nonspecific Cerebrovascular Disorders with CC 230 Other Cardiothoracic Procedures without CC/MCC 072 Nonspecific Cerebrovascular Disorders without 233 Coronary Bypass with Cardiac Catheterization with CC/MCC MCC 085 Traumatic Stupor and Coma, Coma Less Than One Hour 234 Coronary Bypass with Cardiac Catheterization without with MCC MCC 086 Traumatic Stupor and Coma, Coma Less Than One Hour 235 Coronary Bypass without Cardiac Catheterization with with CC MCC 087 Traumatic Stupor and Coma, Coma Less Than One Hour 236 Coronary Bypass without Cardiac Catheterization without CC/MCC without MCC 091 Other Disorders of Nervous System with MCC 239 Amputation for Circulatory System Disorders Except 092 Other Disorders of Nervous System with CC Upper Limb and Toe with MCC 093 Other Disorders of Nervous System without CC/MCC 240 Amputation for Circulatory System Disorders Except Upper Limb and Toe with CC 100 Seizures with MCC 241 Amputation for Circulatory System Disorders Except 101 Seizures without MCC Upper Limb and Toe without CC/MCC 163 Major Chest Procedures with MCC 242 Permanent Cardiac Pacemaker Implant with MCC 164 Major Chest Procedures with CC 243 Permanent Cardiac Pacemaker Implant with CC 165 Major Chest Procedures without CC/MCC 244 Permanent Cardiac Pacemaker Implant without 166 Other Respiratory System O.R. Procedures with MCC CC/MCC 167 Other Respiratory System O.R. Procedures with CC 255 Upper Limb and Toe Amputation for Circulatory System 168 Other Respiratory System O.R. Procedures without Disorders with MCC CC/MCC 256 Upper Limb and Toe Amputation for Circulatory System 175 Pulmonary Embolism with MCC Disorders with CC 176 Pulmonary Embolism without MCC 257 Upper Limb and Toe Amputation for Circulatory System 177 Respiratory Infections and Inflammations with MCC Disorders without CC/MCC 178 Respiratory Infections and Inflammations with CC 264 Other Circulatory System O.R. Procedures 179 Respiratory Infections and Inflammations without 280 Acute Myocardial Infarction, Discharged Alive with CC/MCC MCC