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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 405-pancreas-liver-and-shunt-procedures-with-mcc
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    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.

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    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.

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    Clinical Trials

    • Acute perioperative intervention trials investigating strategies to reduce morbidity and mortality after major pancreatic, hepatic, or portal shunt operations in patients with complex disease and major complications (MCC). These studies enroll critically ill inpatients undergoing resection, transplantation-related hepatectomy, pancreatoduodenectomy, or portal decompression for portal hypertension, and test interventions such as optimized hemodynamic protocols, enhanced intraoperative monitoring, or novel perioperative blood management approaches. Results are directly relevant to surgeons, intensivists, and hospital paying entities because improved perioperative protocols can decrease length of stay, ICU utilization, and expensive complication-related readmissions for this high-cost DRG.
    • Comparative effectiveness trials evaluating surgical techniques and perioperative care pathways for high-risk pancreatic and hepatic procedures in patients with severe comorbidities or postoperative organ dysfunction. These studies compare approaches such as minimally invasive versus open resections, different anastomotic techniques, or standardized care bundles (nutrition, glycemic control, and infection prevention) in heterogeneous inpatient cohorts with high rates of complications. Payers and providers use this evidence to determine which procedural strategies and care pathways yield better outcomes and resource use for patients classified under this DRG, informing coverage decisions and quality improvement initiatives.
    • Post-discharge and long-term outcomes cohort studies assessing readmission drivers, functional recovery, and health-care utilization after index hospitalization for pancreas, liver, or shunt procedures complicated by major complications. These observational studies follow survivors after discharge to quantify rates of recurrent admissions, outpatient resource needs (home health, wound care, hepatic encephalopathy management), and patient-centered outcomes such as return to baseline nutrition and independence. Findings guide discharge planning, transitional care programs, and value-based payment models by identifying modifiable factors that reduce costly readmissions and improve long-term outcomes for this high-risk inpatient population.

    Related Codes

    406-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-CC

    Pancreas, Liver and Shunt Procedures with CC: Inpatient Reimbursement Overview

    407-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITHOUT-CC-MCC

    Pancreas, Liver and Shunt Procedures without CC/MCC: Inpatient Reimbursement Overview

    408-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-MCC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with MCC: Inpatient Reimbursement Overview

    409-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-CC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with CC: Inpatient Reimbursement Overview

    410-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITHOUT-CC-MCC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E.: Inpatient Reimbursement Overview

    411-CHOLECYSTECTOMY-WITH-C-D-E-WITH-MCC

    Cholecystectomy with C.D.E. with MCC: Inpatient Reimbursement Overview

    412-CHOLECYSTECTOMY-WITH-C-D-E-WITH-CC

    Cholecystectomy with Common Duct Exploration with Complication or Comorbidity: Inpatient Reimbursement Overview

    413-CHOLECYSTECTOMY-WITH-C-D-E-WITHOUT-CC-MCC

    Cholecystectomy with C.D.E. without CC/MCC: Inpatient Reimbursement Overview

    414-CHOLECYSTECTOMY-EXCEPT-BY-LAPAROSCOPE-WITHOUT-C-D-E-WITH-MCC

    Cholecystectomy Except by Laparoscope without C.D.E. with MCC: Inpatient Reimbursement Overview

    415-CHOLECYSTECTOMY-EXCEPT-BY-LAPAROSCOPE-WITHOUT-C-D-E-WITH-CC

    Cholecystectomy Except by Laparoscope without C.D.E. with CC: 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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