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    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 228-other-cardiothoracic-procedures-with-mcc
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    Other Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    DRG 228 addresses other cardiothoracic procedures accompanied by a Major Complication or Comorbidity, covering complex operative care of the heart and adjacent structures. This Diagnosis-Related Group is important for inpatient reimbursement because the Major Complication or Comorbidity status elevates payment to reflect increased acuity and resource needs.

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    DRG 228 Overview

    DRG 228 covers hospitalizations for other cardiothoracic procedures when a Major Complication or Comorbidity is present, encompassing complex surgical interventions on the heart, pericardium, or great vessels that do not fall into more specific categories. This Diagnosis-Related Group groups cases with higher resource use due to the presence of significant comorbid conditions or postoperative complications. It matters for Medicare payment because the Major Complication or Comorbidity designation increases relative reimbursement to account for greater inpatient resource consumption and clinical intensity. Accurate coding and documentation of the procedures and the Major Complication or Comorbidity are essential for proper assignment to this Diagnosis-Related Group.

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    Clinical Trials

    • Trials evaluating novel perioperative management strategies for complex cardiothoracic procedures (for example enhanced intraoperative monitoring protocols, blood conservation methods, or rapid-response algorithms for intraoperative complications). These studies enroll adult patients undergoing non-standard cardiothoracic operations who have major comorbidities or intraoperative complications qualifying as MCC, and measure immediate surgical outcomes such as operative morbidity, transfusion requirements, and ICU length of stay. This research is relevant to providers and payers because improvements in perioperative protocols can reduce high-cost complication rates and ICU utilization common in this DRG.
    • Comparative effectiveness studies of alternative surgical approaches or adjunctive technologies used in other cardiothoracic procedures with major complications (for example minimally invasive versus open access for complex resections, or use of mechanical circulatory support as a planned or rescue adjunct). These trials focus on heterogeneous patients with severe cardiac or thoracic disease plus MCC-level complications, comparing postoperative mortality, complication profiles, readmission, and resource utilization between strategies. Payers and hospitals benefit from evidence identifying approaches that balance clinical benefit with expected intensive resource needs and can inform care pathways and pricing for high-acuity cases.
    • Post-discharge outcomes and care-coordination research assessing rehabilitation, home health interventions, and readmission prevention in survivors of complex cardiothoracic procedures with major complications. These prospective cohort or implementation studies follow patients after hospital discharge to evaluate functional recovery, quality of life, rates of late complications, and drivers of 30- to 90-day readmissions among high-risk patients. Findings help providers and payers target transitional care investments and case management strategies to reduce costly readmissions and improve long-term outcomes in this high-risk DRG population.

    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

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

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/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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