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Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview
DRG 221 encompasses cardiac valve and other major cardiothoracic procedures performed without cardiac catheterization and without Major Complication or Comorbidity, defining a cohort of inpatient stays with moderate clinical complexity. This Diagnosis-Related Group matters for inpatient reimbursement because assignment determines Medicare Severity Diagnosis-Related Group-based payment weights that reflect expected resource use.
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DRG 221 Overview
DRG 221 covers inpatient hospitalizations for cardiac valve and other major cardiothoracic procedures performed without cardiac catheterization and without Major Complication or Comorbidity. This Diagnosis-Related Group captures procedures such as isolated valve replacements or repairs and other major open thoracic operations when no higher-severity comorbid conditions are present. It matters for Medicare payment because the grouped classification determines base payment weights and influences resource intensity and reimbursement for hospitals under the inpatient prospective payment system. Accurate coding and documentation of procedures and comorbidities affect whether a case is assigned to this Diagnosis-Related Group and the resulting payment.