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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 067-precerebral-occlusion-without-infarction-with-mcc
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    Precerebral Occlusion without Infarction with MCC: Inpatient Reimbursement Overview

    DRG 067 addresses hospitalizations for precerebral arterial occlusion without infarction when a Major Complication or Comorbidity is present; it covers transient ischemic events or symptomatic vessel occlusion absent completed stroke. Correct assignment to this Diagnosis-Related Group influences Medicare inpatient reimbursement by reflecting the higher expected resource use when a Major Complication or Comorbidity exists.

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    DRG 067 Overview

    DRG 067 covers hospital admissions for precerebral arterial occlusion without established cerebral infarction when a Major Complication or Comorbidity is present. This category includes patients with symptomatic carotid or vertebral artery narrowing or occlusion causing transient ischemic symptoms but without completed stroke, and the presence of a Major Complication or Comorbidity increases resource intensity. It matters for Medicare inpatient reimbursement because classification into this Diagnosis-Related Group affects payment relative to less or more severe cerebrovascular Diagnosis-Related Groups. Accurate documentation of the precipitating vascular condition and the Major Complication or Comorbidity is essential for proper payment assignment.

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    Clinical Trials

    • Acute endovascular and medical management trials focused on preventing progression to cerebral infarction: these studies evaluate timing and efficacy of urgent revascularization procedures (such as carotid or vertebral artery interventions) and adjunctive antithrombotic regimens in patients who present with symptomatic precerebral occlusion but have no established brain infarction on imaging. The patient population includes hospitalized adults with high-grade extracranial or proximal intracranial arterial stenosis/occlusion, often with transient ischemic symptoms, and research questions center on which immediate interventions reduce early stroke conversion and inpatient morbidity. Findings are highly relevant to providers for optimizing in-hospital care pathways and to payers because effective acute strategies can shorten length of stay, reduce need for higher-cost complications, and affect payer-covered procedural and ICU resource utilization.
    • Comparative effectiveness studies of secondary prevention strategies during the inpatient stay: these trials compare different combinations of antiplatelet, anticoagulant, and risk-factor management protocols initiated in hospital for patients with precerebral occlusion without infarction, including subgroups with atrial fibrillation or carotid disease. The target population is medically heterogeneous hospitalized patients at high short-term risk for stroke who may benefit from tailored secondary prevention; research objectives include balancing recurrent event reduction against bleeding and other adverse events. Results inform clinicians on best practice bundles to implement before discharge and inform payers about cost-effectiveness and readmission risk associated with differing inpatient medication and monitoring strategies.
    • Post-discharge outcomes and care-transition studies assessing readmission, functional status, and long-term vascular events: these observational cohorts and interventional trials evaluate discharge planning, outpatient follow-up timing, rehabilitation referral, and adherence programs for patients who had precerebral occlusion without infarction during an index admission. The population includes survivors discharged without infarction but with high vascular risk, with research questions about which transitional care models reduce 30- and 90-day readmissions, new infarcts, or disability. These studies are important to hospitals and payers because improved transitions can lower readmission penalties, reduce downstream high-cost events, and guide reimbursement for outpatient care coordination services.

    Related Codes

    020-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with MCC: Inpatient Reimbursement Overview

    021-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-CC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with CC: Inpatient Reimbursement Overview

    022-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITHOUT-CC-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage without CC/MCC: Inpatient Reimbursement Overview

    023-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITH-MCC-OR-ANTINEOPLASTIC-IMPLANT-OR-EPILEPSY-WITH-NEUROSTIMULATOR

    Craniotomy with Major Device Implant or Complex CNS DRG 023: Inpatient Reimbursement Overview

    024-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITHOUT-MCC

    Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC: Inpatient Reimbursement Overview

    025-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-MCC

    Craniotomy and Endovascular Intracranial Procedures with MCC: Inpatient Reimbursement Overview

    026-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-CC

    Craniotomy and Endovascular Intracranial Procedures with CC: Inpatient Reimbursement Overview

    027-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITHOUT-CC-MCC

    Craniotomy and Endovascular Intracranial Procedures without CC/MCC: Inpatient Reimbursement Overview

    028-SPINAL-PROCEDURES-WITH-MCC

    Spinal Procedures with MCC: Inpatient Reimbursement Overview

    029-SPINAL-PROCEDURES-WITH-CC-OR-SPINAL-NEUROSTIMULATORS

    Spinal Procedures with CC or Spinal Neurostimulators: Inpatient Reimbursement Overview

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    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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