Summary & Overview
Pancreas, Liver and Shunt Procedures with CC: Inpatient Reimbursement Overview
DRG 406 encompasses inpatient pancreas and liver procedures and portosystemic shunt operations when a Complication or Comorbidity is present, covering complex resections and shunt surgeries. It matters for inpatient reimbursement because the presence of a Complication or Comorbidity increases the Diagnosis-Related Group weight and expected resource utilization, impacting Medicare payment.
DRG 406 Overview
DRG 406 covers major inpatient procedures involving the pancreas and liver, as well as surgical creation or revision of portosystemic shunts, when a Complication or Comorbidity is present. Typical cases include resections, complex debridements, biliary-enteric reconstructions, and shunt operations performed for portal hypertension with additional clinical complexity. This Diagnosis-Related Group influences Medicare payment through assignment of higher relative weight when a Complication or Comorbidity is coded, reflecting greater expected resource use. Accurate clinical documentation and coding of the principal procedure and accompanying Complication or Comorbidity affect reimbursement and case mix classification.