KMAP MS-DRG/CMS-DRG and 103 PR S 001 Heart transplant or implant of heart assist system w 103 002 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 480 006 Liver transplant w/o Procedure 4697 (Transplant of intestine) is always assigned to MS-DRG 005 regardless of severity level 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 482 012 Tracheostomy for face,mouth & neck diagnoses w 482 013 Tracheostomy for face,mouth & neck diagnoses w/o 528 01 S 020 Intracranial vascular procedures w PDX hemorrhage w 528 021 Intracranial vascular procedures w PDX hemorrhage w 528 022 Intracranial vascular procedures w PDX hemorrhage w/o 543 01 S 023 Cranio w major dev impl/acute complex CNS PDX w or chemo implant Non-or procedure 0010(Implant chemothera agent) is always assigned to MS-DRG 023 regardless of severity level; Added procedure 0062 to MS-DRG 023-027 Revised 12/07/2007 Page: 1
KMAP MS-DRG/CMS-DRG and 543 024 Cranio w major dev impl/acute complex CNS PDX w/o 001 01 S 025 Craniotomy & endovascular intracranial procedures w 002 026 Craniotomy & endovascular intracranial procedures w 003* 027 Craniotomy & endovascular intracranial procedures w/o *CMS v24 DRG 003 procedures are split between MS-DRGs 025,026,027,031,032,033; Added procedure 0062 to MS-DRG 023-027 531 01 S 028 Spinal procedures w 532 029 Spinal procedures w or spinal Combination of 0393 with (8694 or 8695 or neurostimulators 8697 or 8698) is always assigned to MS-DRG 029 regardless of severity level 532 030 Spinal procedures w/o 529 01 S 031 Ventricular shunt procedures w 530 032 Ventricular shunt procedures w 530 033 Ventricular shunt procedures w/o 577 01 S 034 Carotid artery stent procedure w 577 035 Carotid artery stent procedure w 577 036 Carotid artery stent procedure w/o 533 01 S 037 Extracranial procedures w 534 038 Extracranial procedures w 534 039 Extracranial procedures w/o 006 01 S 040 Periph & cranial nerve & other nerv syst proc w 007 041 Periph/cranial nerve & other nerv Combination of 0492 with (8694 or 8695 or syst proc w or periph neurostim 8697 or 8698) is always assigned to MS-DRG 041 regardless of severity 008 042 Periph & cranial nerve & other nerv syst proc w/o 009 01 M 052 Spinal disorders & injuries w 009 053 Spinal disorders & injuries w/o 010 01 M 054 Nervous system neoplasms w 011 055 Nervous system neoplasms w/o Revised 12/07/2007 Page: 2
KMAP MS-DRG/CMS-DRG and 012 01 M 056 Degenerative nervous system disorders w 012 057 Degenerative nervous system disorders w/o 013 01 M 058 Multiple sclerosis & cerebellar ataxia w 013 059 Multiple sclerosis & cerebellar ataxia w 013 060 Multiple sclerosis & cerebellar ataxia w/o 559 01 M 061 Acute ischemic stroke w use of thrombolytic agent w 559 062 Acute ischemic stroke w use of thrombolytic agent w 559 063 Acute ischemic stroke w use of thrombolytic agent w/o 014 01 M 064 Intracranial hemorrhage or cerebral infarction w 014 065 Intracranial hemorrhage or cerebral infarction w 014 066 Intracranial hemorrhage or cerebral infarction w/o 015 01 M 067 Nonspecific cva & precerebral occlusion w/o infarct w 015 068 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 017 072 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 021 076 Viral meningitis w/o 022 01 M 077 Hypertensive encephalopathy w 022 078 Hypertensive encephalopathy w 022 079 Hypertensive encephalopathy w/o Revised 12/07/2007 Page: 3
KMAP MS-DRG/CMS-DRG and 023 01 M 080 Nontraumatic stupor & coma w 023 081 Nontraumatic stupor & coma w/o 027 01 M 082 Traumatic stupor & coma, coma >1 hr w 027 083 Traumatic stupor & coma, coma >1 hr w 027 084 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 030 087 Traumatic stupor & coma, coma <1 hr w/o 031 01 M 088 Concussion w 032 089 Concussion w 033 090 Concussion w/o 034 01 M 091 Other disorders of nervous system w 035 092 Other disorders of nervous system w 035 093 Other disorders of nervous system w/o 560 01 M 094 Bacterial & tuberculous infections of nervous system w 560 095 Bacterial & tuberculous infections of nervous system w 560 096 Bacterial & tuberculous infections of nervous system w/o 561 01 M 097 Non-bacterial infect of nervous sys exc viral meningitis w 561 098 Non-bacterial infect of nervous sys exc viral meningitis w 561 099 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 564 103 Headaches w/o 037 02 S 113 Orbital procedures w Revised 12/07/2007 Page: 4
KMAP MS-DRG/CMS-DRG and 037 114 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 044 122 Acute major eye infections w/o 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 049 130 Major head & neck procedures w/o Procedures 2096,2097,2098 (cochlear implants) are always assigned to MS-DRG 129 regardless of severity level 049 03 S 131 Cranial/facial procedures w 049 132 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 Revised 12/07/2007 Page: 5
KMAP MS-DRG/CMS-DRG and 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 063 064 03 M 146 Ear, nose, mouth & throat malignancy w 064 147 Ear, nose, mouth & throat malignancy w 064 148 Ear, nose, mouth & throat malignancy w/o 065 03 M 149 Dysequilibrium 066 03 M 150 Epistaxis w 066 151 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 074 156 Nasal trauma & deformity w/o 185 03 M 157 Dental & Oral Diseases w 186 158 Dental & Oral Diseases w 187 159 Dental & Oral Diseases w/o 075 04 S 163 Major chest procedures w 075 164 Major chest procedures w 075 165 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 077 168 Other resp system O.R. procedures w/o Revised 12/07/2007 Page: 6
KMAP MS-DRG/CMS-DRG and 078 04 M 175 Pulmonary embolism w 078 176 Pulmonary embolism w/o 079 04 M 177 Respiratory infections & inflammations w 080 178 Respiratory infections & inflammations w 081 179 Respiratory infections & inflammations w/o 082 04 M 180 Respiratory neoplasms w 082 181 Respiratory neoplasms w 082 182 Respiratory neoplasms w/o 083 04 M 183 Major chest trauma w 084 184 Major chest trauma w 084 185 Major chest trauma w/o 085 04 M 186 Pleural effusion w 086 187 Pleural effusion w 086 188 Pleural effusion w/o 087 04 M 189 Pulmonary edema & respiratory failure 088 04 M 190 Chronic obstructive pulmonary disease w 088 191 Chronic obstructive pulmonary disease w 088 192 Chronic obstructive pulmonary disease w/o 089 04 M 193 Simple pneumonia & pleurisy w 090 194 Simple pneumonia & pleurisy w 091 195 Simple pneumonia & pleurisy w/o 092 04 M 196 Interstitial lung disease w 093 197 Interstitial lung disease w 093 198 Interstitial lung disease w/o 094 04 M 199 Pneumothorax w 095 200 Pneumothorax w 095 201 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 Revised 12/07/2007 Page: 7
KMAP MS-DRG/CMS-DRG and 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 104 217 Cardiac valve & oth maj cardiothoracic proc w card cath w 104 218 Cardiac valve & oth maj cardiothoracic proc w card cath w/o 105 05 S 219 Cardiac valve & oth maj cardiothoracic proc w/o card cath w 105 220 Cardiac valve & oth maj cardiothoracic proc w/o card cath w 105 221 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 535 223 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 536 225 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 515 227 Cardiac defibrillator implant w/o cardiac cath w/o Revised 12/07/2007 Page: 8
KMAP MS-DRG/CMS-DRG and 108 05 S 228 Other cardiothoracic procedures w 108 229 Other cardiothoracic procedures w 108 230 Other cardiothoracic procedures w/o 106 05 S 231 Coronary bypass w PTCA w 106 232 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 cardiovasc procedures w Procedure code 3973 (Endovascular or thoracic aortic anuerysm implantation of graft in thoracic aorta) is repair always assigned to MS-DRG 237 regardless of severity level 111 238 Major cardiovascular procedures w/o 113 05 S 239 Amputation for circ sys disorders exc upper limb & toe w 113 240 Amputation for circ sys disorders exc upper limb & toe w 113 241 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 552 244 Permanent cardiac pacemaker implant w/o 552 05 S 245 AICD lead & generator procedures 557 05 S 246 Perc cardiovasc proc w drugeluting stent w or 4+ vessels/stents 558 247 Perc cardiovasc proc w drugeluting stent w/o Combination procedures (0066 and 3607) with 0043 or 0048 is always assigned to MS- DRG 246 regardless of severity level Revised 12/07/2007 Page: 9
KMAP MS-DRG/CMS-DRG and 555 05 S 248 Perc cardiovasc proc w non-drugeluting Combination procedures (0066 and 3606) stent w or 4+ with 0043 or 0048 is always assigned to MS- ves/stents DRG 248 regardless of severity level 556 249 Perc cardiovasc proc w non-drugeluting stent w/o 518 05 S 250 Perc cardiovasc proc w/o coronary artery stent or AMI w 518 251 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 554 254 Other vascular procedures w/o 114 05 S 255 Upper limb & toe amputation for circ system disorders w 114 256 Upper limb & toe amputation for circ system disorders w 114 257 Upper limb & toe amputation for circ system disorders w/o 118 05 S 258 Cardiac pacemaker device replacement w 118 259 Cardiac pacemaker device replacement w/o 117 05 S 260 Cardiac pacemaker revision except device replacement w 117 261 Cardiac pacemaker revision except device replacement w 117 262 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 122 282 Acute myocardial infarction, discharged alive w/o Revised 12/07/2007 Page: 10
KMAP MS-DRG/CMS-DRG and 123 05 M 283 Acute myocardial infarction, expired w 123 284 Acute myocardial infarction, expired w 123 285 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 126 289 Acute & subacute endocarditis w 126 290 Acute & subacute endocarditis w/o 127 05 M 291 Heart failure & shock w 127 292 Heart failure & shock w 127 293 Heart failure & shock w/o 128 05 M 294 Deep vein thrombophlebitis w 128 295 Deep vein thrombophlebitis w/o 129 05 M 296 Cardiac arrest, unexplained w 129 297 Cardiac arrest, unexplained w 129 298 Cardiac arrest, unexplained w/o 130 05 M 299 Peripheral vascular disorders w 131 300 Peripheral vascular disorders w 131 301 Peripheral vascular disorders w/o 132 05 M 302 Atherosclerosis w 133 303 Atherosclerosis w/o 134 05 M 304 Hypertension w 134 305 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 Revised 12/07/2007 Page: 11
KMAP MS-DRG/CMS-DRG and 139 309 Cardiac arrhythmia & conduction disorders w 139 310 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 145 316 Other circulatory system diagnoses w/o 155 06 S 326 Stomach, esophageal & duodenal proc w 156 327 Stomach, esophageal & duodenal proc w 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 570 331 Major small & large bowel procedures w/o 146 06 S 332 Rectal resection w 147 333 Rectal resection w 147 334 Rectal resection w/o 150 06 S 335 Peritoneal adhesiolysis w 151 336 Peritoneal adhesiolysis w 151 337 Peritoneal adhesiolysis w/o 164 06 S 338 Appendectomy w complicated principal diag w 165 339 Appendectomy w complicated principal diag w 165 340 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 Revised 12/07/2007 Page: 12
KMAP MS-DRG/CMS-DRG and 167 343 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 153 346 Minor small & large bowel procedures w/o 157 06 S 347 Anal & stomal procedures w 158 348 Anal & stomal procedures w 158 349 Anal & stomal procedures w/o 161 06 S 350 Inguinal & femoral hernia procedures w *CMS v24 DRG 163 procedures are split between MS-DRGs 350,351,352,353,354,355 162 351 Inguinal & femoral hernia procedures w 163* 352 Inguinal & femoral hernia procedures w/o 159 06 S 353 Hernia procedures except inguinal & femoral w 160 354 Hernia procedures except inguinal & femoral w 160 355 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 171 358 Other digestive system O.R. procedures w/o 571 06 M 368 Major esophageal disorders w 571 369 Major esophageal disorders w 571 370 Major esophageal disorders w/o 572 06 M 371 Major gastrointestinal disorders & peritoneal infections w 572 372 Major gastrointestinal disorders & peritoneal infections w 572 373 Major gastrointestinal disorders & peritoneal infections w/o 172 06 M 374 Digestive malignancy w 173 375 Digestive malignancy w 173 376 Digestive malignancy w/o Revised 12/07/2007 Page: 13
KMAP MS-DRG/CMS-DRG and 174 06 M 377 G.I. hemorrhage w 175 378 G.I. hemorrhage w 175 379 G.I. hemorrhage w/o 176 06 M 380 Complicated peptic ulcer w 176 381 Complicated peptic ulcer w 176 382 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 179 386 Inflammatory bowel disease w 179 387 Inflammatory bowel disease w/o 180 06 M 388 G.I. obstruction w 181 389 G.I. obstruction w 181 390 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 190 395 Other digestive system diagnoses w/o 191 07 S 405 Pancreas, liver & shunt procedures w 192 406 Pancreas, liver & shunt procedures w 192 407 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 194 410 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 Revised 12/07/2007 Page: 14
KMAP MS-DRG/CMS-DRG and 196 413 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 198 416 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 494 419 Laparoscopic cholecystectomy w/o c.d.e. w/o 199 07 S 420 Hepatobiliary diagnostic procedures w 200 421 Hepatobiliary diagnostic procedures w 200 422 Hepatobiliary diagnostic procedures w/o 201 07 S 423 Other hepatobiliary or pancreas O.R. procedures w 201 424 Other hepatobiliary or pancreas O.R. procedures w 201 425 Other hepatobiliary or pancreas O.R. procedures w/o 202 07 M 432 Cirrhosis & alcoholic hepatitis w 202 433 Cirrhosis & alcoholic hepatitis w 202 434 Cirrhosis & alcoholic hepatitis w/o 203 07 M 435 Malignancy of hepatobiliary system or pancreas w 203 436 Malignancy of hepatobiliary system or pancreas w 203 437 Malignancy of hepatobiliary system or pancreas w/o 204 07 M 438 Disorders of pancreas except malignancy w 204 439 Disorders of pancreas except malignancy w 204 440 Disorders of pancreas except malignancy w/o 205 07 M 441 Disorders of liver except malig,cirr,alc hepa w 206 442 Disorders of liver except malig,cirr,alc hepa w Revised 12/07/2007 Page: 15
KMAP MS-DRG/CMS-DRG and 206 443 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 208 446 Disorders of the biliary tract w/o 496 08 S 453 Combined anterior/posterior spinal fusion w 496 454 Combined anterior/posterior spinal fusion w 496 455 Combined anterior/posterior spinal fusion w/o 546 08 S 456 Spinal fus exc cerv w spinal Addition of infections to PDX list and criteria curv/malig/infec or 9+ fus w of spinal fusion with non-or procedure 8164 will assign to MS-DRGs 456-458 546 457 Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w 546 458 Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus 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 471 462 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 217 464 Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w 217 465 Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o 545 08 S 466 Revision of hip or knee replacement w 545 467 Revision of hip or knee replacement w 545 468 Revision of hip or knee replacement w/o 544 08 S 469 Major joint replacement or reattachment of lower extremity w Revised 12/07/2007 Page: 16
KMAP MS-DRG/CMS-DRG and 544 470 Major joint replacement or reattachment of lower extremity w/o 519 08 S 471 Cervical spinal fusion w 520 472 Cervical spinal fusion w 520 473 Cervical spinal fusion w/o 213 08 S 474 Amputation for musculoskeletal sys & conn tissue dis w 213 475 Amputation for musculoskeletal sys & conn tissue dis w 213 476 Amputation for musculoskeletal sys & conn tissue dis w/o 216 08 S 477 Biopsies of musculoskeletal system & connective tissue w 216 478 Biopsies of musculoskeletal system & connective tissue w 216 479 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 212 482 Hip & femur procedures except major joint w/o 491 08 S 483 Major joint & limb reattachment proc of upper extremity w 491 484 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 502 487 Knee procedures w pdx of infection w/o 503 08 S 488 Knee procedures w/o pdx of infection w 503 489 Knee procedures w/o pdx of infection w/o Added procedure codes 0083 and 0084 to MS-DRGs 485-489 Added procedure codes 0083 and 0084 to MS-DRGs 485-489 Revised 12/07/2007 Page: 17
KMAP MS-DRG/CMS-DRG and 499 08 S 490 Back & neck proc exc spinal Procedures 8459, 8462, 8465, 8480, 8482, fusion w or disc 8484 are always assigned to MS-DRG 490 device/neurostim regardless of severity level; Combination 0393 with (8694 or 8695 or 8697 or 8698) is always assigned to MS-DRG 490 regardless of severity level 500 491 Back & neck proc exc spinal fusion w/o 218 08 S 492 Lower extrem & humer proc except hip,foot,femur w 219 493 Lower extrem & humer proc except hip,foot,femur w 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 538 497 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 230 499 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 227 502 Soft tissue procedures w/o 225 08 S 503 Foot procedures w 225 504 Foot procedures w 225 505 Foot procedures w/o 228 08 S 506 Major thumb or joint procedures 223 08 S 507 Major shoulder or elbow joint procedures w 223 508 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 Revised 12/07/2007 Page: 18
KMAP MS-DRG/CMS-DRG and 224 511 Shoulder,elbow or forearm proc,exc major joint proc w 224 512 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 229 514 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 234 517 Other musculoskelet sys & conn tiss O.R. proc w/o 235 08 M 533 Fractures of femur w 235 534 Fractures of femur w/o 236 08 M 535 Fractures of hip & pelvis w 236 536 Fractures of hip & pelvis w/o 237 08 M 537 Sprains, strains, & dislocations of hip, pelvis & thigh w 237 538 Sprains, strains, & dislocations of hip, pelvis & thigh w/o 238 08 M 539 Osteomyelitis w 238 540 Osteomyelitis w 238 541 Osteomyelitis w/o 239 08 M 542 Pathological fractures & musculoskelet & conn tiss malig w 239 543 Pathological fractures & musculoskelet & conn tiss malig w 239 544 Pathological fractures & musculoskelet & conn tiss malig w/o 240 08 M 545 Connective tissue disorders w 241 546 Connective tissue disorders w 241 547 Connective tissue disorders w/o 242 08 M 548 Septic arthritis w Revised 12/07/2007 Page: 19
KMAP MS-DRG/CMS-DRG and 242 549 Septic arthritis w 242 550 Septic arthritis w/o 243 08 M 551 Medical back problems w 243 552 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 247 556 Signs & symptoms of musculoskeletal system & conn tissue w/o 248 08 M 557 Tendonitis, myositis & bursitis w 248 558 Tendonitis, myositis & bursitis w/o 249 08 M 559 Aftercare, musculoskeletal system & connective tissue w 249 560 Aftercare, musculoskeletal system & connective tissue w 249 561 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 256 565 Other musculoskeletal sys & connective tissue diagnoses w 256 566 Other musculoskeletal sys & connective tissue diagnoses w/o 263 09 S 573 Skin graft &/or debrid for skn ulcer or cellulitis w Revised 12/07/2007 Page: 20
KMAP MS-DRG/CMS-DRG and 264 574 Skin graft &/or debrid for skn ulcer or cellulitis w 264 575 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 266 578 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 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 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 271 593 Skin ulcers w 271 594 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 275 599 Malignant breast disorders w/o 276 09 M 600 Non-malignant breast disorders w 276 601 Non-malignant breast disorders w/o 277 09 M 602 Cellulitis w 278 603 Cellulitis w/o 262 Revised 12/07/2007 Page: 21
KMAP MS-DRG/CMS-DRG and 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 286 615 Adrenal & pituitary procedures w/o 285 10 S 616 Amputat of lower limb for endocrine,nutrit,& metabol dis w 285 617 Amputat of lower limb for endocrine,nutrit,& metabol dis w 285 618 Amputat of lower limb for endocrine,nutrit,& metabol dis w/o 288 10 S 619 O.R. procedures for obesity w 288 620 O.R. procedures for obesity w 288 621 O.R. procedures for obesity w/o 287 10 S 622 Skin grafts & wound debrid for endoc, nutrit & metab dis w 287 623 Skin grafts & wound debrid for endoc, nutrit & metab dis w 287 624 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 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 293 630 Other endocrine, nutrit & metab O.R. proc w/o 294 10 M 637 Diabetes w 295 638 Diabetes w 295 639 Diabetes w/o Revised 12/07/2007 Page: 22
KMAP MS-DRG/CMS-DRG and 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 301 645 Endocrine disorders w/o 302 11 S 652 Kidney transplant 573 11 S 653 Major bladder procedures w 573 654 Major bladder procedures w 573 655 Major bladder procedures w/o 303 11 S 656 Kidney & ureter procedures for neoplasm w 303 657 Kidney & ureter procedures forneoplasm w 303 658 Kidney & ureter procedures for neoplasm w/o 304 11 S 659 Kidney & ureter procedures for non-neoplasm w 305 660 Kidney & ureter procedures for non-neoplasm w 305 661 Kidney & ureter procedures for non-neoplasm w/o 308 11 S 662 Minor bladder procedures w 309 663 Minor bladder procedures w 309 664 Minor bladder procedures w/o 306 11 S 665 Prostatectomy w 307 666 Prostatectomy w 307 667 Prostatectomy w/o 310 11 S 668 Transurethral procedures w 311 669 Transurethral procedures w 311 670 Transurethral procedures w/o 312 11 S 671 Urethral procedures w 313 672 Urethral procedures w/o Revised 12/07/2007 Page: 23
KMAP MS-DRG/CMS-DRG and 314 315 11 S 673 Other kidney & urinary tract procedures w 315 674 Other kidney & urinary tract procedures w 315 675 Other kidney & urinary tract procedures w/o 316 11 M 682 Renal failure w 316 683 Renal failure w 316 684 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 319 688 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 323 692 Urinary stones w esw lithotripsy w/o 324 11 M 693 Urinary stones w/o esw lithotripsy w 324 694 Urinary stones w/o esw lithotripsy w/o 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 333 700 Other kidney & urinary tract diagnoses w/o 334 12 S 707 Major male pelvic procedures w Revised 12/07/2007 Page: 24
KMAP MS-DRG/CMS-DRG and 335 708 Major male pelvic procedures w/o 341 12 S 709 Penis procedures w 341 710 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 344 716 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 345 718 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 347 724 Malignancy, male reproductive system w/o 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 350 728 Inflammation of the male reproductive system w/o 351 12 M 729 Other male reproductive system diagnoses w Revised 12/07/2007 Page: 25
KMAP MS-DRG/CMS-DRG and 352 730 Other male reproductive system diagnoses w/o 353 13 S 734 Pelvic evisceration, rad hysterectomy & rad vulvectomy w 353 735 Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o 357 13 S 736 Uterine & adnexa proc for ovarian or adnexal malignancy w 357 737 Uterine & adnexa proc for ovarian or adnexal malignancy w 357 738 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 355 741 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 360 747 Vagina, cervix & vulva procedures w/o 356 13 S 748 Female reproductive system reconstructive procedures 365 13 S 749 Other female reproductive system O.R. procedures w 365 750 Other female reproductive system O.R. procedures w/o Revised 12/07/2007 Page: 26
KMAP MS-DRG/CMS-DRG and 366 13 M 754 Malignancy, female reproductive system w 367 755 Malignancy, female reproductive system w 367 756 Malignancy, female reproductive system w/o 368 13 M 757 Infections, female reproductive system w 368 758 Infections, female reproductive system w 368 759 Infections, female reproductive system w/o 369 13 M 760 Menstrual & other female reproductive system disorders w 369 761 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 373 14 M 775 Vaginal delivery w/o complicating diagnoses 376 14 M 776 Postpartum & post abortion diagnoses w/o O.R. procedure Revised 12/07/2007 Page: 27
KMAP MS-DRG/CMS-DRG and 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 391 15 M 795 Normal newborn Revised 12/07/2007 Page: 28
KMAP MS-DRG/CMS-DRG and 392 16 S 799 Splenectomy w 393 800 Splenectomy w 393 801 Splenectomy w/o 394 16 S 802 Other O.R. proc of the blood & blood forming organs w 394 803 Other O.R. proc of the blood & blood forming organs w 394 804 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 574 809 Major hematol/immun diag exc sickle cell crisis & coagul w 574 810 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 399 816 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 540 822 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 402 825 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 407 827 Myeloprolif disord or poorly diff neopl w maj O.R. proc w Revised 12/07/2007 Page: 29
KMAP MS-DRG/CMS-DRG and 407 828 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 408 830 Myeloprolif disord or poorly diff neopl w other O.R. proc w/o 405 473 17 M 834 Acute leukemia w/o major O.R. procedure w 473 835 Acute leukemia w/o major O.R. procedure w 405 836 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 492 838 Chemo w acute leukemia as sdx w or high dose chemo agent 492 839 Chemo w acute leukemia as sdx w/o 403 17 M 840 Lymphoma & non-acute leukemia w 404 841 Lymphoma & non-acute leukemia w 404 842 Lymphoma & non-acute leukemia w/o Non-or procedure 0015 will minimally be assigned to 838 with or without the presence of a 411 17 M 843 Other myeloprolif dis or poorly diff neopl diag w 412 844 Other myeloprolif dis or poorly diff neopl diag w 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 410 847 Chemotherapy w/o acute leukemia as secondary diagnosis w 410 848 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 578 854 Infectious & parasitic diseases w O.R. procedure w Revised 12/07/2007 Page: 30
KMAP MS-DRG/CMS-DRG and 578 855 Infectious & parasitic diseases w O.R. procedure w/o 579 18 S 856 Postoperative or post-traumatic infections w O.R. proc w 579 857 Postoperative or post-traumatic infections w O.R. proc w 579 858 Postoperative or post-traumatic infections w O.R. proc w/o 418 18 M 862 Postoperative & post-traumatic infections w 418 863 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 423 868 Other infectious & parasitic diseases diagnoses w 423 869 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 576 872 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 Revised 12/07/2007 Page: 31
KMAP MS-DRG/CMS-DRG and 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 523 897 Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o 440 21 S 901 Wound debridements for injuries w 440 902 Wound debridements for injuries w 440 903 Wound debridements for injuries w/o 439 21 S 904 Skin grafts for injuries w 439 905 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 Revised 12/07/2007 Page: 32
KMAP MS-DRG/CMS-DRG and 443 908 Other O.R. procedures for injuries w 443 909 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 453 921 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 461 940 O.R. proc w diagnoses of other contact w health services w 461 941 O.R. proc w diagnoses of other contact w health services w/o Revised 12/07/2007 Page: 33
KMAP MS-DRG/CMS-DRG and 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 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 486 958 Other O.R. procedures for multiple significant trauma w 486 959 Other O.R. procedures for multiple significant trauma w/o 487 24 M 963 Other multiple significant trauma w 487 964 Other multiple significant trauma w 487 965 Other multiple significant trauma w/o 488 25 S 969 HIV w extensive O.R. procedure w 488 970 HIV w extensive O.R. procedure w/o 489 25 M 974 HIV w major related condition w 489 975 HIV w major related condition w 489 976 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 468 982 Extensive O.R. procedure unrelated to principal diagnosis w 468 983 Extensive O.R. procedure unrelated to principal diagnosis w/o Revised 12/07/2007 Page: 34
KMAP MS-DRG/CMS-DRG and 476 S 984 Prostatic O.R. procedure unrelated to principal diagnosis w 476 985 Prostatic O.R. procedure unrelated to principal diagnosis w 476 986 Prostatic O.R. procedure unrelated to principal diagnosis w/o 477 S 987 Non-extensive O.R. proc unrelated to principal diagnosis w 477 988 Non-extensive O.R. proc unrelated to principal diagnosis w 477 989 Non-extensive O.R. proc unrelated to principal diagnosis w/o 469 * 998 Principal diagnosis invalid as discharge diagnosis 470 * 999 Ungroupable Revised 12/07/2007 Page: 35