Summary & Overview
Pancreas, Liver and Shunt Procedures with MCC: Inpatient Reimbursement Overview
DRG 405 encompasses major pancreas, liver, and shunt procedures with Major Complication or Comorbidity; it includes high-acuity operative cases that substantially affect inpatient resource use. This matters for inpatient reimbursement because the Diagnosis-Related Group assignment and presence of Major Complication or Comorbidity directly influence Medicare payment levels for these complex surgical admissions.
DRG 405 Overview
DRG 405 covers inpatient admissions for major pancreatic, hepatic, and portal-systemic shunt operations performed for complex disease, typically accompanied by a Major Complication or Comorbidity. These procedures are high-resource and can involve extensive operative time, critical care, and prolonged recovery, which drives elevated Medicare inpatient reimbursement. Accurate DRG assignment affects hospital payment and reflects the clinical intensity and resource consumption of these cases. Documentation of procedures and coexisting severe diagnoses is central to proper billing under Centers for Medicare & Medicaid Services rules.