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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 307-cardiac-congenital-and-valvular-disorders-without-mcc
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    Cardiac Congenital and Valvular Disorders without MCC: Inpatient Reimbursement Overview

    DRG 307 encompasses inpatient stays for cardiac congenital and valvular disorders without Major Complication or Comorbidity, capturing cases managed without severe concurrent conditions. Correct grouping is important for Medicare inpatient reimbursement because it determines payment level, reflects expected resource use, and hinges on documentation and coding of comorbidities and procedures.

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    DRG 307 Overview

    DRG 307 covers inpatient admissions for cardiac congenital and valvular disorders without Major Complication or Comorbidity and includes procedures and diagnoses related to congenital heart defects and valvular disease managed without severe concurrent conditions. This Diagnosis-Related Group groups patients by clinical similarity and resource use to determine Medicare payment for the episode of care. It matters because classification into this Diagnosis-Related Group affects payment rates, length-of-stay considerations, and billing documentation requirements for Centers for Medicare & Medicaid Services reimbursement. Accurate coding and capture of comorbidities influence whether an admission qualifies for this Diagnosis-Related Group versus a higher-paying group with Major Complication or Comorbidity.

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    Clinical Trials

    • Perioperative and procedural intervention trials evaluating timing and techniques for valve repair versus replacement in non-MCC valvular disease: These studies enroll adult and pediatric patients with congenital valvular lesions or acquired valvular disease requiring admission but without major complications, comparing specific surgical approaches (minimally invasive vs open, repair techniques) or perioperative management protocols (anticoagulation strategies, myocardial protection). The objective is to determine which procedural choices and intraoperative care pathways reduce length of stay, readmissions, and complications; findings inform surgeons and hospital administrators about resource use, expected recovery trajectories, and short-term reimbursement implications for DRG 307 admissions.
    • Comparative effectiveness and medical management trials for conservative therapy in symptomatic but non-MCC valvular and congenital cardiac disorders: These trials focus on patients admitted for heart failure symptoms, arrhythmia management, or symptomatic congenital lesions who are managed non-surgically or are optimized before elective intervention, comparing different medical regimens, timing of intervention, or device-based monitoring strategies. The goal is to identify which inpatient management approaches best stabilize patients, reduce conversion to higher-acuity care, and minimize subsequent admissions, providing payers and clinicians evidence to guide utilization, length of stay, and case-mix adjustments under this DRG.
    • Post-discharge outcomes, care-transition, and long-term functional status studies tracking readmissions and quality-of-life after hospitalization for congenital or valvular disorders without major complications: These observational or randomized care-management trials enroll patients discharged after index admission to evaluate transitional care interventions (structured follow-up, remote monitoring, rehabilitation) and measure 30- and 90-day readmission rates, functional recovery, and outpatient resource use. Such research is relevant because improved discharge planning and outpatient management can lower readmissions and downstream costs, influence bundled payment strategies, and help hospitals and payers optimize post-acute resource allocation for patients categorized in DRG 307.

    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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