103 PR S 001 Heart transplant or implant of heart assist system w 002 Heart transplant or implant of heart assist system w/o 541 PR S 003 ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R. 542 PR S 004 Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R. 480 PR S 005 Liver transplant w or intestinal transplant Procedure 4697 (Transplant of intestine) is always assigned to MS-DRG 005 regardless of severity level 006 Liver transplant w/o 495 PR S 007 Lung transplant 512 PR S 008 Simultaneous pancreas/kidney transplant 481 PR S 009 Bone marrow transplant 513 PR S 010 Pancreas transplant 482 PR S 011 Tracheostomy for face,mouth & neck diagnoses w 012 Tracheostomy for face,mouth & neck diagnoses w CC 013 Tracheostomy for face,mouth & neck diagnoses w/o 528 01 S 020 Intracranial vascular procedures w PDX hemorrhage w 021 Intracranial vascular procedures w PDX hemorrhage w CC 022 Intracranial vascular procedures w PDX hemorrhage w/o 543 01 S 023 Craniotomy w major device implant or acute complex CNS PDX w 024 Craniotomy w major device implant or acute complex CNS PDX w/o 001 01 S 025 Craniotomy & endovascular intracranial procedures w *CMS v24 DRG 003 procedures are split between MS- DRGs 025,026,027,031,032,033 SMAInformtics.Inc www.smainformatics.com Page1 of 33
002 026 Craniotomy & endovascular intracranial procedures w CC 003* 027 Craniotomy & endovascular intracranial procedures w/o 531 01 S 028 Spinal procedures w 532 029 Spinal procedures w CC 030 Spinal procedures w/o 529 01 S 031 Ventricular shunt procedures w 530 032 Ventricular shunt procedures w CC 033 Ventricular shunt procedures w/o 577 01 S 034 Carotid artery stent procedure w 035 Carotid artery stent procedure w CC 036 Carotid artery stent procedure w/o 533 01 S 037 Extracranial procedures w 534 038 Extracranial procedures w CC 039 Extracranial procedures w/o 006 01 S 040 Periph & cranial nerve & other nerv syst proc w 007 041 Periph & cranial nerve & other nerv syst proc w CC 008 042 Periph & cranial nerve & other nerv syst proc w/o 009 01 M 052 Spinal disorders & injuries w 053 Spinal disorders & injuries w/o 010 01 M 054 Nervous system neoplasms w 011 055 Nervous system neoplasms w/o 012 01 M 056 Degenerative nervous system disorders w 057 Degenerative nervous system disorders w/o 013 01 M 058 Multiple sclerosis & cerebellar ataxia w 059 Multiple sclerosis & cerebellar ataxia w CC 060 Multiple sclerosis & cerebellar ataxia w/o 559 01 M 061 Acute ischemic stroke w use of thrombolytic agent w SMAInformtics.Inc www.smainformatics.com Page2 of 33
062 Acute ischemic stroke w use of thrombolytic agent w CC 063 Acute ischemic stroke w use of thrombolytic agent w/o 014 01 M 064 Intracranial hemorrhage or cerebral infarction w 065 Intracranial hemorrhage or cerebral infarction w CC 066 Intracranial hemorrhage or cerebral infarction w/o 015 01 M 067 Nonspecific cva & precerebral occlusion w/o infarct w 068 Nonspecific cva & precerebral occlusion w/o infarct w/o 524 01 M 069 Transient ischemia 016 01 M 070 Nonspecific cerebrovascular disorders w 017 071 Nonspecific cerebrovascular disorders w CC 072 Nonspecific cerebrovascular disorders w/o 018 01 M 073 Cranial & peripheral nerve disorders w 019 074 Cranial & peripheral nerve disorders w/o 021 01 M 075 Viral meningitis w 076 Viral meningitis w/o 022 01 M 077 Hypertensive encephalopathy w 078 Hypertensive encephalopathy w CC 079 Hypertensive encephalopathy w/o 023 01 M 080 Nontraumatic stupor & coma w 081 Nontraumatic stupor & coma w/o 027 01 M 082 Traumatic stupor & coma, coma >1 hr w 083 Traumatic stupor & coma, coma >1 hr w CC 084 Traumatic stupor & coma, coma >1 hr w/o 028 01 M 085 Traumatic stupor & coma, coma <1 hr w 029 086 Traumatic stupor & coma, coma <1 hr w CC SMAInformtics.Inc www.smainformatics.com Page3 of 33
030 087 Traumatic stupor & coma, coma <1 hr w/o 031 01 M 088 Concussion w 032 089 Concussion w CC 033 090 Concussion w/o 034 01 M 091 Other disorders of nervous system w 035 092 Other disorders of nervous system w CC 093 Other disorders of nervous system w/o 560 01 M 094 Bacterial & tuberculous infections of nervous system w 095 Bacterial & tuberculous infections of nervous system w CC 096 Bacterial & tuberculous infections of nervous system w/o 561 01 M 097 Non-bacterial infect of nervous sys exc viral meningitis w 098 Non-bacterial infect of nervous sys exc viral meningitis w CC 099 Non-bacterial infect of nervous sys exc viral meningitis w/o 026* 01 M 100 Seizures w * CMS v24 DRG 026 PDX are split between MS-DRGs 100,101,102,103 562 101 Seizures w/o 563 564 01 M 102 Headaches w 103 Headaches w/o 037 02 S 113 Orbital procedures w 114 Orbital procedures w/o 040 02 S 115 Extraocular procedures except orbit 041 036 02 S 116 Intraocular procedures w 038 117 Intraocular procedures w/o 039 042 044 02 M 121 Acute major eye infections w 122 Acute major eye infections w/o SMAInformtics.Inc www.smainformatics.com Page4 of 33
045 02 M 123 Neurological eye disorders 043 02 M 124 Other disorders of the eye w 046 125 Other disorders of the eye w/o 047 048 049 03 S 129 Major head & neck procedures w or major device 130 Major head & neck procedures w/o Procedures 2096,2097,2098 (cochlear implants) are always assigned to MS-DRG 129 regardless of severity level 03 S 131 Cranial/facial procedures w 132 Cranial/facial procedures w/o 052 03 S 133 Other ear, nose, mouth & throat O.R. procedures w 055 134 Other ear, nose, mouth & throat O.R. procedures w/o 056 057 058 059 060 061 062 063 053 03 S 135 Sinus & mastoid procedures w 054 136 Sinus & mastoid procedures w/o 168 03 S 137 Mouth procedures w 169 138 Mouth procedures w/o 050 03 S 139 Salivary gland procedures 051 064 03 M 146 Ear, nose, mouth & throat malignancy w 147 Ear, nose, mouth & throat malignancy w CC 148 Ear, nose, mouth & throat malignancy w/o 065 03 M 149 Dysequilibrium 066 03 M 150 Epistaxis w SMAInformtics.Inc www.smainformatics.com Page5 of 33
151 Epistaxis w/o 067 03 M 152 Otitis media & URI w 068 153 Otitis media & URI w/o 069 070 071 072 03 M 154 Nasal trauma & deformity w 073 155 Nasal trauma & deformity w CC 074 156 Nasal trauma & deformity w/o 185 03 M 157 Dental & Oral Diseases w 186 158 Dental & Oral Diseases w CC 187 159 Dental & Oral Diseases w/o 075 04 S 163 Major chest procedures w 164 Major chest procedures w CC 165 Major chest procedures w/o 076 04 S 166 Other resp system O.R. procedures w 077 167 Other resp system O.R. procedures w CC 168 Other resp system O.R. procedures w/o 078 04 M 175 Pulmonary embolism w 176 Pulmonary embolism w/o 079 04 M 177 Respiratory infections & inflammations w 080 178 Respiratory infections & inflammations w CC 081 179 Respiratory infections & inflammations w/o 082 04 M 180 Respiratory neoplasms w 181 Respiratory neoplasms w CC 182 Respiratory neoplasms w/o 083 04 M 183 Major chest trauma w 084 184 Major chest trauma w CC 185 Major chest trauma w/o 085 04 M 186 Pleural effusion w 086 187 Pleural effusion w CC 188 Pleural effusion w/o 087 04 M 189 Pulmonary edema & respiratory failure 088 04 M 190 Chronic obstructive pulmonary disease w SMAInformtics.Inc www.smainformatics.com Page6 of 33
191 Chronic obstructive pulmonary disease w CC 192 Chronic obstructive pulmonary disease w/o 089 04 M 193 Simple pneumonia & pleurisy w 090 194 Simple pneumonia & pleurisy w CC 091 195 Simple pneumonia & pleurisy w/o 092 04 M 196 Interstitial lung disease w 093 197 Interstitial lung disease w CC 198 Interstitial lung disease w/o 094 04 M 199 Pneumothorax w 095 200 Pneumothorax w CC 201 Pneumothorax w/o 096 04 M 202 Bronchitis & asthma w 097 203 Bronchitis & asthma w/o 098 099 04 M 204 Respiratory signs & symptoms 100 101 04 M 205 Other respiratory system diagnoses w 102 206 Other respiratory system diagnoses w/o 565 04 M 207 Respiratory system diagnosis w ventilator support 96+ hours 566 04 M 208 Respiratory system diagnosis w ventilator support <96 hours 525 05 S 215 Other heart assist system implant 104 05 S 216 Cardiac valve & oth maj cardiothoracic proc w card cath w 217 Cardiac valve & oth maj cardiothoracic proc w card cath w CC 218 Cardiac valve & oth maj cardiothoracic proc w card cath w/o SMAInformtics.Inc www.smainformatics.com Page7 of 33
105 05 S 219 Cardiac valve & oth maj cardiothoracic proc w/o card cath w 220 Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC 221 Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o 535 05 S 222 Cardiac defib implant w cardiac cath w AMI/HF/shock w 223 Cardiac defib implant w cardiac cath w AMI/HF/shock w/o 536 05 S 224 Cardiac defib implant w cardiac cath w/o AMI/HF/shock w 225 Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o 515 05 S 226 Cardiac defibrillator implant w/o cardiac cath w 227 Cardiac defibrillator implant w/o cardiac cath w/o 108 05 S 228 Other cardiothoracic procedures w 229 Other cardiothoracic procedures w CC 230 Other cardiothoracic procedures w/o 106 05 S 231 Coronary bypass w PTCA w 232 Coronary bypass w PTCA w/o 547 05 S 233 Coronary bypass w cardiac cath w 548 234 Coronary bypass w cardiac cath w/o 549 05 S 235 Coronary bypass w/o cardiac cath w 550 236 Coronary bypass w/o cardiac cath w/o 110 05 S 237 Major cardiovascular procedures w 111 238 Major cardiovascular procedures w/o 113 05 S 239 Amputation for circ sys disorders exc upper limb & toe w SMAInformtics.Inc www.smainformatics.com Page8 of 33
240 Amputation for circ sys disorders exc upper limb & toe w CC 241 Amputation for circ sys disorders exc upper limb & toe w/o 551 05 S 242 Permanent cardiac pacemaker implant w 552 243 Permanent cardiac pacemaker implant w CC 244 Permanent cardiac pacemaker implant w/o 05 S 245 AICD lead & generator procedures 557 05 S 246 Percutaneous cardiovascular proc w drug-eluting stent w 558 247 Percutaneous cardiovascular proc w drug-eluting stent w/o 555 05 S 248 Percutaneous cardiovasc proc w non-drug-eluting stent w 556 249 Percutaneous cardiovasc proc w non-drug-eluting stent w/o 518 05 S 250 Perc cardiovasc proc w/o coronary artery stent or AMI w 251 Perc cardiovasc proc w/o coronary artery stent or AMI w/o 479 05 S 252 Other vascular procedures w 553 253 Other vascular procedures w CC 554 254 Other vascular procedures w/o 114 05 S 255 Upper limb & toe amputation for circ system disorders w 256 Upper limb & toe amputation for circ system disorders w CC 257 Upper limb & toe amputation for circ system disorders w/o 118 05 S 258 Cardiac pacemaker device replacement w 259 Cardiac pacemaker device replacement w/o 117 05 S 260 Cardiac pacemaker revision except device replacement w SMAInformtics.Inc www.smainformatics.com Page9 of 33
261 Cardiac pacemaker revision except device replacement w CC 262 Cardiac pacemaker revision except device replacement w/o 119 05 S 263 Vein ligation & stripping 120 05 S 264 Other circulatory system O.R. procedures 121 05 M 280 Acute myocardial infarction, discharged alive w 122 281 Acute myocardial infarction, discharged alive w CC 282 Acute myocardia infarction, discharged alive w/o 123 05 M 283 Acute myocardial infarction, expired w 284 Acute myocardial infarction, expired w CC 285 Acute myocardial infarction, expired w/o 124 05 M 286 Circulatory disorders except AMI, w card cath w 125 287 Circulatory disorders except AMI, w card cath w/o 126 05 M 288 Acute & subacute endocarditis w 289 Acute & subacute endocarditis w CC 290 Acute & subacute endocarditis w/o 127 05 M 291 Heart failure & shock w 292 Heart failure & shock w CC 293 Heart failure & shock w/o 128 05 M 294 Deep vein thrombophlebitis w 295 Deep vein thrombophlebitis w/o 129 05 M 296 Cardiac arrest, unexplained w 297 Cardiac arrest, unexplained w CC 298 Cardiac arrest, unexplained w/o 130 05 M 299 Peripheral vascular disorders w SMAInformtics.Inc www.smainformatics.com Page10 of 33
131 300 Peripheral vascular disorders w CC 301 Peripheral vascular disorders w/o 132 05 M 302 Atherosclerosis w 133 303 Atherosclerosis w/o 134 05 M 304 Hypertension w 305 Hypertension w/o 135 05 M 306 Cardiac congenital & valvular disorders w 136 307 Cardiac congenital & valvular disorders w/o 137 138 05 M 308 Cardiac arrhythmia & conduction disorders w 139 309 Cardiac arrhythmia & conduction disorders w CC 310 Cardiac arrhythmia & conduction disorders w/o 140 05 M 311 Angina pectoris 141 05 M 312 Syncope & collapse 142 143 05 M 313 Chest pain 144 05 M 314 Other circulatory system diagnoses w 145 315 Other circulatory system diagnoses w CC 316 Other circulatory system diagnoses w/o 155 06 S 326 Stomach, esophageal & duodenal proc w 156 327 Stomach, esophageal & duodenal proc w CC 567 328 Stomach, esophageal & duodenal proc w/o 568 149 06 S 329 Major small & large bowel procedures w 569 330 Major small & large bowel procedures w CC 570 331 Major small & large bowel procedures w/o 146 06 S 332 Rectal resection w 147 333 Rectal resection w CC 334 Rectal resection w/o SMAInformtics.Inc www.smainformatics.com Page11 of 33
150 06 S 335 Peritoneal adhesiolysis w 151 336 Peritoneal adhesiolysis w CC 337 Peritoneal adhesiolysis w/o 164 06 S 338 Appendectomy w complicated principal diag w 165 339 Appendectomy w complicated principal diag w CC 340 Appendectomy w complicated principal diag w/o 166 06 S 341 Appendectomy w/o complicated principal diag w 167 342 Appendectomy w/o complicated principal diag w CC 343 Appendectomy w/o complicated principal diag w/o 152 06 S 344 Minor small & large bowel procedures w 153 345 Minor small & large bowel procedures w CC 346 Minor small & large bowel procedures w/o 157 06 S 347 Anal & stomal procedures w 158 348 Anal & stomal procedures w CC 349 Anal & stomal procedures w/o 161 06 S 350 Inguinal & femoral hernia procedures w 162 351 Inguinal & femoral hernia procedures w CC 163* 352 Inguinal & femoral hernia procedures w/o *CMS v24 DRG 163 procedures are split between MS- DRGs 350,351,352,353,354,355 159 06 S 353 Hernia procedures except inguinal & femoral w 160 354 Hernia procedures except inguinal & femoral w CC 355 Hernia procedures except inguinal & femoral w/o 170 06 S 356 Other digestive system O.R. procedures w 171 357 Other digestive system O.R. procedures w CC 358 Other digestive system O.R. procedures w/o 571 06 M 368 Major esophageal disorders w 369 Major esophageal disorders w CC 370 Major esophageal disorders w/o 572 06 M 371 Major gastrointestinal disorders & peritoneal infections w SMAInformtics.Inc www.smainformatics.com Page12 of 33
372 Major gastrointestinal disorders & peritoneal infections w CC 373 Major gastrointestinal disorders & peritoneal infections w/o 172 06 M 374 Digestive malignancy w 173 375 Digestive malignancy w CC 376 Digestive malignancy w/o 174 06 M 377 G.I. hemorrhage w 175 378 G.I. hemorrhage w CC 379 G.I. hemorrhage w/o 176 06 M 380 Complicated peptic ulcer w 381 Complicated peptic ulcer w CC 382 Complicated peptic ulcer w/o 177 06 M 383 Uncomplicated peptic ulcer w 178 384 Uncomplicated peptic ulcer w/o 179 06 M 385 Inflammatory bowel disease w 386 Inflammatory bowel disease w CC 387 Inflammatory bowel disease w/o 180 06 M 388 G.I. obstruction w 181 389 G.I. obstruction w CC 390 G.I. obstruction w/o 182 06 M 391 Esophagitis, gastroent & misc digest disorders w 183 392 Esophagitis, gastroent & misc digest disorders w/o 184 188 06 M 393 Other digestive system diagnoses w 189 394 Other digestive system diagnoses w CC 190 395 Other digestive system diagnoses w/o 191 07 S 405 Pancreas, liver & shunt procedures w 192 406 Pancreas, liver & shunt procedures w CC 407 Pancreas, liver & shunt procedures w/o 193 07 S 408 Biliary tract proc except only cholecyst w or w/o c.d.e. w 194 409 Biliary tract proc except only cholecyst w or w/o c.d.e. w CC SMAInformtics.Inc www.smainformatics.com Page13 of 33
410 Biliary tract proc except only cholecyst w or w/o c.d.e. w/o 195 07 S 411 Cholecystectomy w c.d.e. w 196 412 Cholecystectomy w c.d.e. w CC 413 Cholecystectomy w c.d.e. w/o 197 07 S 414 Cholecystectomy except by laparoscope w/o c.d.e. w 198 415 Cholecystectomy except by laparoscope w/o c.d.e. w CC 416 Cholecystectomy except by laparoscope w/o c.d.e. w/o 493 07 S 417 Laparoscopic cholecystectomy w/o c.d.e. w 494 418 Laparoscopic cholecystectomy w/o c.d.e. w CC 419 Laparoscopic cholecystectomy w/o c.d.e. w/o 199 07 S 420 Hepatobiliary diagnostic procedures w 200 421 Hepatobiliary diagnostic procedures w CC 422 Hepatobiliary diagnostic procedures w/o 201 07 S 423 Other hepatobiliary or pancreas O.R. procedures w 424 Other hepatobiliary or pancreas O.R. procedures w CC 425 Other hepatobiliary or pancreas O.R. procedures w/o 202 07 M 432 Cirrhosis & alcoholic hepatitis w 433 Cirrhosis & alcoholic hepatitis w CC 434 Cirrhosis & alcoholic hepatitis w/o 203 07 M 435 Malignancy of hepatobiliary system or pancreas w 436 Malignancy of hepatobiliary system or pancreas w CC 437 Malignancy of hepatobiliary system or pancreas w/o 204 07 M 438 Disorders of pancreas except malignancy w 439 Disorders of pancreas except malignancy w CC 440 Disorders of pancreas except malignancy w/o 205 07 M 441 Disorders of liver except malig,cirr,alc hepa w SMAInformtics.Inc www.smainformatics.com Page14 of 33
206 442 Disorders of liver except malig,cirr,alc hepa w CC 443 Disorders of liver except malig,cirr,alc hepa w/o 207 07 M 444 Disorders of the biliary tract w 208 445 Disorders of the biliary tract w CC 446 Disorders of the biliary tract w/o 496 08 S 453 Combined anterior/posterior spinal fusion w 454 Combined anterior/posterior spinal fusion w CC 455 Combined anterior/posterior spinal fusion w/o 546 08 S 456 Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w 457 Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC 458 Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w/o 497 08 S 459 Spinal fusion except cervical w 498 460 Spinal fusion except cervical w/o 471 08 S 461 Bilateral or multiple major joint procs of lower extremity w 462 Bilateral or multiple major joint procs of lower extremity w/o 217 08 S 463 Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w 464 Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC 465 Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o 545 08 S 466 Revision of hip or knee replacement w 467 Revision of hip or knee replacement w CC 468 Revision of hip or knee replacement w/o 544 08 S 469 Major joint replacement or reattachment of lower extremity w 470 Major joint replacement or reattachment of lower extremity w/o SMAInformtics.Inc www.smainformatics.com Page15 of 33
519 08 S 471 Cervical spinal fusion w 520 472 Cervical spinal fusion w CC 473 Cervical spinal fusion w/o 213 08 S 474 Amputation for musculoskeletal sys & conn tissue dis w 475 Amputation for musculoskeletal sys & conn tissue dis w CC 476 Amputation for musculoskeletal sys & conn tissue dis w/o 216 08 S 477 Biopsies of musculoskeletal system & connective tissue w 478 Biopsies of musculoskeletal system & connective tissue w CC 479 Biopsies of musculoskeletal system & connective tissue w/o 210 08 S 480 Hip & femur procedures except major joint w 211 481 Hip & femur procedures except major joint w CC 212 482 Hip & femur procedures except major joint w/o 491 08 S 483 Major joint & limb reattachment proc of upper extremity w 484 Major joint & limb reattachment proc of upper extremity w/o 501 08 S 485 Knee procedures w pdx of infection w 502 486 Knee procedures w pdx of infection w CC 487 Knee procedures w pdx of infection w/o 503 08 S 488 Knee procedures w/o pdx of infection w 489 Knee procedures w/o pdx of infection w/o 499 08 S 490 Back & neck procedures except spinal fusion w or disc devices 500 491 Back & neck procedures except spinal fusion w/o Procedures 8458,8459, 8465 are always assigned to MS-DRG 490 regardless of severity level 218 08 S 492 Lower extrem & humer proc except hip,foot,femur w 219 493 Lower extrem & humer proc except hip,foot,femur w CC SMAInformtics.Inc www.smainformatics.com Page16 of 33
220 494 Lower extrem & humer proc except hip,foot,femur w/o 537 08 S 495 Local excision & removal int fix devices exc hip & femur w 538 496 Local excision & removal int fix devices exc hip & femur w CC 497 Local excision & removal int fix devices exc hip & femur w/o 230 08 S 498 Local excision & removal int fix devices of hip & femur w 499 Local excision & removal int fix devices of hip & femur w/o 226 08 S 500 Soft tissue procedures w 227 501 Soft tissue procedures w CC 502 Soft tissue procedures w/o 225 08 S 503 Foot procedures w 504 Foot procedures w CC 505 Foot procedures w/o 228 08 S 506 Major thumb or joint procedures 223 08 S 507 Major shoulder or elbow joint procedures w 508 Major shoulder or elbow joint procedures w/o 232 08 S 509 Arthroscopy 224 08 S 510 Shoulder,elbow or forearm proc,exc major joint proc w 511 Shoulder,elbow or forearm proc,exc major joint proc w CC 512 Shoulder,elbow or forearm proc,exc major joint proc w/o 229 08 S 513 Hand or wrist proc, except major thumb or joint proc w 514 Hand or wrist proc, except major thumb or joint proc w/o 233 08 S 515 Other musculoskelet sys & conn tiss O.R. proc w 234 516 Other musculoskelet sys & conn tiss O.R. proc w CC 517 Other musculoskelet sys & conn tiss O.R. proc w/o SMAInformtics.Inc www.smainformatics.com Page17 of 33
235 08 M 533 Fractures of femur w 534 Fractures of femur w/o 236 08 M 535 Fractures of hip & pelvis w 536 Fractures of hip & pelvis w/o 237 08 M 537 Sprains, strains, & dislocations of hip, pelvis & thigh w 538 Sprains, strains, & dislocations of hip, pelvis & thigh w/o 238 08 M 539 Osteomyelitis w 540 Osteomyelitis w CC 541 Osteomyelitis w/o 239 08 M 542 Pathological fractures & musculoskelet & conn tiss malig w 543 Pathological fractures & musculoskelet & conn tiss malig w CC 544 Pathological fractures & musculoskelet & conn tiss malig w/o 240 08 M 545 Connective tissue disorders w 241 546 Connective tissue disorders w CC 547 Connective tissue disorders w/o 242 08 M 548 Septic arthritis w 549 Septic arthritis w CC 550 Septic arthritis w/o 243 08 M 551 Medical back problems w 552 Medical back problems w/o 244 08 M 553 Bone diseases & arthropathies w 245 554 Bone diseases & arthropathies w/o 246 247 08 M 555 Signs & symptoms of musculoskeletal system & conn tissue w 556 Signs & symptoms of musculoskeletal system & conn tissue w/o 248 08 M 557 Tendonitis, myositis & bursitis w SMAInformtics.Inc www.smainformatics.com Page18 of 33
558 Tendonitis, myositis & bursitis w/o 249 08 M 559 Aftercare, musculoskeletal system & connective tissue w 560 Aftercare, musculoskeletal system & connective tissue w CC 561 Aftercare, musculoskeletal system & connective tissue w/o 250 08 M 562 Fx, sprn, strn & disl except femur, hip, pelvis & thigh w 251 563 Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o 252 253 254 255 256 08 M 564 Other musculoskeletal sys & connective tissue diagnoses w 565 Other musculoskeletal sys & connective tissue diagnoses w CC 566 Other musculoskeletal sys & connective tissue diagnoses w/o 263 09 S 573 Skin graft &/or debrid for skn ulcer or cellulitis w 264 574 Skin graft &/or debrid for skn ulcer or cellulitis w CC 575 Skin graft &/or debrid for skn ulcer or cellulitis w/o 265 09 S 576 Skin graft &/or debrid exc for skin ulcer or cellulitis w 266 577 Skin graft &/or debrid exc for skin ulcer or cellulitis w CC 578 Skin graft &/or debrid exc for skin ulcer or cellulitis w/o 267 09 S 579 Other skin, subcut tiss & breast proc w 268 580 Other skin, subcut tiss & breast proc w CC 269 581 Other skin, subcut tiss & breast proc w/o 270 257 09 S 582 Mastectomy for malignancy w 258 583 Mastectomy for malignancy w/o SMAInformtics.Inc www.smainformatics.com Page19 of 33
259 09 S 584 Breast biopsy, local excision & other breast procedures w 260 585 Breast biopsy, local excision & other breast procedures w/o 261 262 271 09 M 592 Skin ulcers w 593 Skin ulcers w CC 594 Skin ulcers w/o 272 09 M 595 Major skin disorders w 273 596 Major skin disorders w/o 274 09 M 597 Malignant breast disorders w 275 598 Malignant breast disorders w CC 599 Malignant breast disorders w/o 276 09 M 600 Non-malignant breast disorders w 601 Non-malignant breast disorders w/o 277 09 M 602 Cellulitis w 278 603 Cellulitis w/o 279 280 09 M 604 Trauma to the skin, subcut tiss & breast w 281 605 Trauma to the skin, subcut tiss & breast w/o 282 283 09 M 606 Minor skin disorders w 284 607 Minor skin disorders w/o 286 10 S 614 Adrenal & pituitary procedures w 615 Adrenal & pituitary procedures w/o 285 10 S 616 Amputat of lower limb for endocrine,nutrit,& metabol dis w 617 Amputat of lower limb for endocrine,nutrit,& metabol dis w CC 618 Amputat of lower limb for endocrine,nutrit,& metabol dis w/o 288 10 S 619 O.R. procedures for obesity w 620 O.R. procedures for obesity w CC SMAInformtics.Inc www.smainformatics.com Page20 of 33
621 O.R. procedures for obesity w/o 287 10 S 622 Skin grafts & wound debrid for endoc, nutrit & metab dis w 623 Skin grafts & wound debrid for endoc, nutrit & metab dis w CC 624 Skin grafts & wound debrid for endoc, nutrit & metab dis w/o 289 10 S 625 Thyroid, parathyroid & thyroglossal procedures w 290 626 Thyroid, parathyroid & thyroglossal procedures w CC 291 627 Thyroid, parathyroid & thyroglossal procedures w/o 292 10 S 628 Other endocrine, nutrit & metab O.R. proc w 293 629 Other endocrine, nutrit & metab O.R. proc w CC 630 Other endocrine, nutrit & metab O.R. proc w/o 294 10 M 637 Diabetes w 295 638 Diabetes w CC 639 Diabetes w/o 296 10 M 640 Nutritional & misc metabolic disorders w 297 641 Nutritional & misc metabolic disorders w/o 298 299 10 M 642 Inborn errors of metabolism 300 10 M 643 Endocrine disorders w 301 644 Endocrine disorders w CC 645 Endocrine disorders w/o 302 11 S 652 Kidney transplant 573 11 S 653 Major bladder procedures w 654 Major bladder procedures w CC 655 Major bladder procedures w/o 303 11 S 656 Kidney & ureter procedures for neoplasm w 657 Kidney & ureter procedures forneoplasm w CC 658 Kidney & ureter procedures for neoplasm w/o 304 11 S 659 Kidney & ureter procedures for nonneoplasm w SMAInformtics.Inc www.smainformatics.com Page21 of 33
305 660 Kidney & ureter procedures for nonneoplasm w CC 661 Kidney & ureter procedures for nonneoplasm w/o 308 11 S 662 Minor bladder procedures w 309 663 Minor bladder procedures w CC 664 Minor bladder procedures w/o 306 11 S 665 Prostatectomy w 307 666 Prostatectomy w CC 667 Prostatectomy w/o 310 11 S 668 Transurethral procedures w 311 669 Transurethral procedures w CC 670 Transurethral procedures w/o 312 11 S 671 Urethral procedures w 313 672 Urethral procedures w/o 314 315 11 S 673 Other kidney & urinary tract procedures w 674 Other kidney & urinary tract procedures w CC 675 Other kidney & urinary tract procedures w/o 316 11 M 682 Renal failure w 683 Renal failure w CC 684 Renal failure w/o 317 11 M 685 Admit for renal dialysis 318 11 M 686 Kidney & urinary tract neoplasms w 319 687 Kidney & urinary tract neoplasms w CC 688 Kidney & urinary tract neoplasms w/o 320 11 M 689 Kidney & urinary tract infections w 321 690 Kidney & urinary tract infections w/o 322 323 11 M 691 Urinary stones w esw lithotripsy w 692 Urinary stones w esw lithotripsy w/o 324 11 M 693 Urinary stones w/o esw lithotripsy w 694 Urinary stones w/o esw lithotripsy w/o SMAInformtics.Inc www.smainformatics.com Page22 of 33
325 11 M 695 Kidney & urinary tract signs & symptoms w 326 696 Kidney & urinary tract signs & symptoms w/o 327 328 11 M 697 Urethral stricture 329 330 331 11 M 698 Other kidney & urinary tract diagnoses w 332 699 Other kidney & urinary tract diagnoses w CC 333 700 Other kidney & urinary tract diagnoses w/o 334 12 S 707 Major male pelvic procedures w 335 708 Major male pelvic procedures w/o 341 12 S 709 Penis procedures w 710 Penis procedures w/o 338 12 S 711 Testes procedures w 339 712 Testes procedures w/o 340 336 12 S 713 Transurethral prostatectomy w 337 714 Transurethral prostatectomy w/o 344 12 S 715 Other male reproductive system O.R. proc for malignancy w 716 Other male reproductive system O.R. proc for malignancy w/o 345 12 S 717 Other male reproductive system O.R. proc exc malignancy w 718 Other male reproductive system O.R. proc exc malignancy w/o 342 CMS v24 DRG 342/343 deleted. OR procedure 640 (Circumcision) changed to Non-OR. 343 346 12 M 722 Malignancy, male reproductive system w 347 723 Malignancy, male reproductive system w CC 724 Malignancy, male reproductive system w/o SMAInformtics.Inc www.smainformatics.com Page23 of 33
348 12 M 725 Benign prostatic hypertrophy w 349 726 Benign prostatic hypertrophy w/o 350 12 M 727 Inflammation of the male reproductive system w 728 Inflammation of the male reproductive system w/o 351 12 M 729 Other male reproductive system diagnoses w 352 730 Other male reproductive system diagnoses w/o 353 13 S 734 Pelvic evisceration, rad hysterectomy & rad vulvectomy w 735 Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o 357 13 S 736 Uterine & adnexa proc for ovarian or adnexal malignancy w 737 Uterine & adnexa proc for ovarian or adnexal malignancy w CC 738 Uterine & adnexa proc for ovarian or adnexal malignancy w/o 354 13 S 739 Uterine,adnexa proc for nonovarian/adnexal malig w 355 740 Uterine,adnexa proc for nonovarian/adnexal malig w CC 741 Uterine,adnexa proc for nonovarian/adnexal malig w/o 358 13 S 742 Uterine & adnexa proc for nonmalignancy w 359 743 Uterine & adnexa proc for nonmalignancy w/o 361 13 S 744 D&C, conization, laparoscopy & tubal interruption w 362 745 D&C, conization, laparoscopy & tubal interruption w/o 363 364 360 13 S 746 Vagina, cervix & vulva procedures w 747 Vagina, cervix & vulva procedures w/o SMAInformtics.Inc www.smainformatics.com Page24 of 33
356 13 S 748 Female reproductive system reconstructive procedures 365 13 S 749 Other female reproductive system O.R. procedures w 750 Other female reproductive system O.R. procedures w/o 366 13 M 754 Malignancy, female reproductive system w 367 755 Malignancy, female reproductive system w CC 756 Malignancy, female reproductive system w/o 368 13 M 757 Infections, female reproductive system w 758 Infections, female reproductive system w CC 759 Infections, female reproductive system w/o 369 13 M 760 Menstrual & other female reproductive system disorders w 761 Menstrual & other female reproductive system disorders w/o 370 14 S 765 Cesarean section w 371 766 Cesarean section w/o 374 14 S 767 Vaginal delivery w sterilization &/or D&C 375 14 S 768 Vaginal delivery w O.R. proc except steril &/or D&C 377 14 S 769 Postpartum & post abortion diagnoses w O.R. procedure 381 14 S 770 Abortion w D&C, aspiration curettage or hysterotomy 372 14 M 774 Vaginal delivery w complicating diagnoses SMAInformtics.Inc www.smainformatics.com Page25 of 33
373 14 M 775 Vaginal delivery w/o complicating diagnoses 376 14 M 776 Postpartum & post abortion diagnoses w/o O.R. procedure 378 14 M 777 Ectopic pregnancy 379 14 M 778 Threatened abortion 380 14 M 779 Abortion w/o D&C 382 14 M 780 False labor 383 14 M 781 Other antepartum diagnoses w medical complications 384 14 M 782 Other antepartum diagnoses w/o medical complications 385 15 M 789 Neonates, died or transferred to another acute care facility 386 15 M 790 Extreme immaturity or respiratory distress syndrome, neonate 387 15 M 791 Prematurity w major problems 388 15 M 792 Prematurity w/o major problems 389 15 M 793 Full term neonate w major problems 390 15 M 794 Neonate w other significant problems SMAInformtics.Inc www.smainformatics.com Page26 of 33
391 15 M 795 Normal newborn 392 16 S 799 Splenectomy w 393 800 Splenectomy w CC 801 Splenectomy w/o 394 16 S 802 Other O.R. proc of the blood & blood forming organs w 803 Other O.R. proc of the blood & blood forming organs w CC 804 Other O.R. proc of the blood & blood forming organs w/o 574 16 M 808 Major hematol/immun diag exc sickle cell crisis & coagul w 809 Major hematol/immun diag exc sickle cell crisis & coagul w CC 810 Major hematol/immun diag exc sickle cell crisis & coagul w/o 395 16 M 811 Red blood cell disorders w 396 812 Red blood cell disorders w/o 397 16 M 813 Coagulation disorders 398 16 M 814 Reticuloendothelial & immunity disorders w 399 815 Reticuloendothelial & immunity disorders w CC 816 Reticuloendothelial & immunity disorders w/o 539 17 S 820 Lymphoma & leukemia w major O.R. procedure w 540 821 Lymphoma & leukemia w major O.R. procedure w CC 822 Lymphoma & leukemia w major O.R. procedure w/o 401 17 S 823 Lymphoma & non-acute leukemia w other O.R. proc w 402 824 Lymphoma & non-acute leukemia w other O.R. proc w CC 825 Lymphoma & non-acute leukemia w other O.R. proc w/o 406 17 S 826 Myeloprolif disord or poorly diff neopl w maj O.R. proc w SMAInformtics.Inc www.smainformatics.com Page27 of 33
407 827 Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC 828 Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o 408 17 S 829 Myeloprolif disord or poorly diff neopl w other O.R. proc w 830 Myeloprolif disord or poorly diff neopl w other O.R. proc w/o 405 17 M 834 Acute leukemia w/o major O.R. procedure w 473 835 Acute leukemia w/o major O.R. procedure w CC 836 Acute leukemia w/o major O.R. procedure w/o 492 17 M 837 Chemo w acute leukemia as sdx or w high dose chemo agent w 838 Chemo w acute leukemia as sdx or w high dose chemo agent w CC 839 Chemo w acute leukemia as sdx or w high dose chemo agent w/o 403 17 M 840 Lymphoma & non-acute leukemia w 404 841 Lymphoma & non-acute leukemia w CC 842 Lymphoma & non-acute leukemia w/o 411 17 M 843 Other myeloprolif dis or poorly diff neopl diag w 412 844 Other myeloprolif dis or poorly diff neopl diag w CC 413 845 Other myeloprolif dis or poorly diff neopl diag w/o 414 410 17 M 846 Chemotherapy w/o acute leukemia as secondary diagnosis w 847 Chemotherapy w/o acute leukemia as secondary diagnosis w CC 848 Chemotherapy w/o acute leukemia as secondary diagnosis w/o 409 17 M 849 Radiotherapy 578 18 S 853 Infectious & parasitic diseases w O.R. procedure w SMAInformtics.Inc www.smainformatics.com Page28 of 33
854 Infectious & parasitic diseases w O.R. procedure w CC 855 Infectious & parasitic diseases w O.R. procedure w/o 579 18 S 856 Postoperative or post-traumatic infections w O.R. proc w 857 Postoperative or post-traumatic infections w O.R. proc w CC 858 Postoperative or post-traumatic infections w O.R. proc w/o 418 18 M 862 Postoperative & post-traumatic infections w 863 Postoperative & post-traumatic infections w/o 419 18 M 864 Fever of unknown origin 420 421 18 M 865 Viral illness w *CMS v24 422 PDX split between MS-DRGs 864,865,866 422* 866 Viral illness w/o 423 18 M 867 Other infectious & parasitic diseases diagnoses w 868 Other infectious & parasitic diseases diagnoses w CC 869 Other infectious & parasitic diseases diagnoses w/o 417 18 M 870 Septicemia w MV 96+ hours 575 576 18 M 871 Septicemia w/o MV 96+ hours w 872 Septicemia w/o MV 96+ hours w/o 424 19 S 876 O.R. procedure w principal diagnoses of mental illness 425 19 M 880 Acute adjustment reaction & psychosocial dysfunction 426 19 M 881 Depressive neuroses 427 19 M 882 Neuroses except depressive SMAInformtics.Inc www.smainformatics.com Page29 of 33
428 19 M 883 Disorders of personality & impulse control 429 19 M 884 Organic disturbances & mental retardation 430 19 M 885 Psychoses 431 19 M 886 Behavioral & developmental disorders 432 19 M 887 Other mental disorder diagnoses 433 20 M 894 Alcohol/drug abuse or dependence, left ama 521 20 M 895 Alcohol/drug abuse or dependence w rehabilitation therapy 522 523 20 M 896 Alcohol/drug abuse or dependence w/o rehabilitation therapy w 897 Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o 440 21 S 901 Wound debridements for injuries w 902 Wound debridements for injuries w CC 903 Wound debridements for injuries w/o 439 21 S 904 Skin grafts for injuries w 905 Skin grafts for injuries w/o 441 21 S 906 Hand procedures for injuries 442 21 S 907 Other O.R. procedures for injuries w 443 908 Other O.R. procedures for injuries w CC SMAInformtics.Inc www.smainformatics.com Page30 of 33
909 Other O.R. procedures for injuries w/o 444 21 M 913 Traumatic injury w 445 914 Traumatic injury w/o 446 447 21 M 915 Allergic reactions w 448 916 Allergic reactions w/o 449 21 M 917 Poisoning & toxic effects of drugs w 450 918 Poisoning & toxic effects of drugs w/o 451 452 21 M 919 Complications of treatment w 453 920 Complications of treatment w CC 921 Complications of treatment w/o 454 21 M 922 Other injury, poisoning & toxic effect diag w 455 923 Other injury, poisoning & toxic effect diag w/o 504 22 S 927 Extensive burns or full thickness burns w MV 96+ hrs w skin graft 506 22 S 928 Full thickness burn w skin graft or inhal inj w 507 929 Full thickness burn w skin graft or inhal inj w/o 505 22 M 933 Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft 508 22 M 934 Full thickness burn w/o skin grft or inhal inj 509 510 22 M 935 Non-extensive burns 511 461 23 S 939 O.R. proc w diagnoses of other contact w health services w 940 O.R. proc w diagnoses of other contact w health services w CC 941 O.R. proc w diagnoses of other contact w health services w/o 462 23 M 945 Rehabilitation w 946 Rehabilitation w/o 463 23 M 947 Signs & symptoms w 464 948 Signs & symptoms w/o 465 23 M 949 Aftercare w SMAInformtics.Inc www.smainformatics.com Page31 of 33
466 950 Aftercare w/o 467 23 M 951 Other factors influencing health status 484 24 S 955 Craniotomy for multiple significant trauma 485 24 S 956 Limb reattachment, hip & femur proc for multiple significant trauma 486 24 S 957 Other O.R. procedures for multiple significant trauma w 958 Other O.R. procedures for multiple significant trauma w CC 959 Other O.R. procedures for multiple significant trauma w/o 487 24 M 963 Other multiple significant trauma w 964 Other multiple significant trauma w CC 965 Other multiple significant trauma w/o 488 25 S 969 HIV w extensive O.R. procedure w 970 HIV w extensive O.R. procedure w/o 489 25 M 974 HIV w major related condition w 975 HIV w major related condition w CC 976 HIV w major related condition w/o 490 25 M 977 HIV w or w/o other related condition 468 S 981 Extensive O.R. procedure unrelated to principal diagnosis w 982 Extensive O.R. procedure unrelated to principal diagnosis w CC 983 Extensive O.R. procedure unrelated to principal diagnosis w/o 476 S 984 Prostatic O.R. procedure unrelated to principal diagnosis w 985 Prostatic O.R. procedure unrelated to principal diagnosis w CC SMAInformtics.Inc www.smainformatics.com Page32 of 33
986 Prostatic O.R. procedure unrelated to principal diagnosis w/o 477 S 987 Non-extensive O.R. proc unrelated to principal diagnosis w 988 Non-extensive O.R. proc unrelated to principal diagnosis w CC 989 Non-extensive O.R. proc unrelated to principal diagnosis w/o 469 * 998 Principal diagnosis invalid as discharge diagnosis 470 * 999 Ungroupable SMAInformtics.Inc www.smainformatics.com Page33 of 33