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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 406-pancreas-liver-and-shunt-procedures-with-cc
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    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.

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    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.

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    Clinical Trials

    • Perioperative intervention trials assessing techniques to reduce perioperative morbidity and shorten length of stay after complex pancreatic or hepatic resections: these studies enroll adults undergoing pancreaticoduodenectomy, distal pancreatectomy, hepatic resection, or surgical shunt procedures and compare specific intraoperative strategies (for example enhanced hemostasis protocols, anesthesia approaches, or prophylactic measures against pancreatic fistula and bile leak). The objective is to reduce postoperative complications such as hemorrhage, pancreatic fistula, biliary leak, and sepsis that drive CC-level resource use; results are directly relevant to surgeons, hospital quality teams, and payers because improved protocols can lower ICU utilization and readmissions. - Comparative effectiveness studies of surgical versus endovascular or minimally invasive approaches for portal hypertension and liver-related shunt procedures: these trials examine populations with portal hypertension, variceal bleeding risk, or refractory ascites who are candidates for surgical shunts, transjugular intrahepatic portosystemic shunt alternatives, or hybrid approaches, comparing outcomes like rebleeding, hepatic encephalopathy, and overall resource utilization. The goal is to define which approach yields the best balance of durable clinical benefit and lower downstream costs in patients with significant comorbidity; findings inform procedural selection, discharge planning, and payer decisions about coverage and expected postprocedural care needs. - Post-discharge outcomes and care coordination studies focused on readmission reduction and long-term functional recovery after complex pancreas and liver surgeries: these observational cohorts or interventional care-model trials follow patients after discharge to evaluate multimodal rehabilitation, nutrition support, outpatient surveillance strategies, and early complication detection in patients with postoperative complications or who required intensive inpatient resources. By targeting high-risk patients who incurred CC-level complications, this research identifies interventions that reduce 30- and 90-day readmissions, emergency department visits, and prolonged outpatient resource use, outcomes that matter to hospitals and payers aiming to improve quality metrics and control post-acute spending.

    Related Codes

    405-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-MCC

    Pancreas, Liver and Shunt Procedures with MCC: 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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