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    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 221-cardiac-valve-and-other-major-cardiothoracic-procedures-without-cardiac-catheterization-without-cc-mcc
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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.

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    Clinical Trials

    • Acute procedural optimization studies: randomized or prospective studies evaluating intraoperative strategies, surgical techniques, or perioperative management protocols for patients undergoing open cardiac valve replacement or major cardiothoracic procedures without concomitant cardiac catheterization. These trials enroll predominantly adult patients with severe valvular disease or complex thoracic pathology scheduled for index operative repair or replacement, and they measure intraoperative metrics (ischemic time, blood loss), early morbidity (bleeding, infection, arrhythmia), and 30-day mortality to define best practices. Results are directly relevant to surgeons, anesthesiologists, and hospital administrators because optimized intraoperative care can reduce complications, shorten ICU and inpatient length of stay, and therefore affect DRG resource use and reimbursement risk.
    • Comparative effectiveness and device/technique studies: noninferiority or pragmatic trials comparing alternative valve prostheses (e.g., bioprosthetic vs mechanical where applicable), sutureless valves, or different surgical approaches (minimally invasive thoracotomy vs full sternotomy) in patients eligible for major cardiothoracic procedures without catheterization. These studies target subgroups such as older adults with multiple comorbidities, reoperative patients, or those with specific anatomic considerations, and they evaluate outcomes including valve function, reoperation rates, functional status, and mid-term survival. Payers and health systems use this evidence to inform coverage decisions, implant selection, and care pathways that balance device cost, durability, and downstream utilization within the DRG population.
    • Post-discharge outcomes and care-transition research: cohort studies or randomized interventions testing enhanced recovery after surgery (ERAS) bundles, structured cardiac rehabilitation referral, remote monitoring, or readmission-prevention programs for survivors of major valve or cardiothoracic surgery. These trials focus on the early post-discharge period and enroll patients at hospital discharge, measuring readmissions, outpatient resource use, patient-reported outcomes, and cost-effectiveness over 30–90 days and up to 1 year. This research is important to providers and payers because reducing readmissions and improving functional recovery can lower total episode-of-care costs under the DRG payment model and improve quality metrics tied to reimbursement and value-based programs.

    Related Codes

    209-COMPLEX-AORTIC-ARCH-PROCEDURES

    Complex Aortic Arch Procedures: Inpatient Reimbursement Overview

    212-CONCOMITANT-AORTIC-AND-MITRAL-VALVE-PROCEDURES

    Concomitant Aortic and Mitral Valve Procedures: Inpatient Reimbursement Overview

    213-ENDOVASCULAR-ABDOMINAL-AORTA-WITH-ILIAC-BRANCH-PROCEDURES

    Endovascular Abdominal Aorta with Iliac Branch Procedures: Inpatient Reimbursement Overview

    215-OTHER-HEART-ASSIST-SYSTEM-IMPLANT

    Other Heart Assist System Implant: Inpatient Reimbursement Overview

    216-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

    217-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    218-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

    219-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    220-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    228-OTHER-CARDIOTHORACIC-PROCEDURES-WITH-MCC

    Other Cardiothoracic Procedures with MCC: 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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