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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 407-pancreas-liver-and-shunt-procedures-without-cc-mcc
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    Pancreas, Liver and Shunt Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 407 covers pancreas, liver, and shunt procedures without Complication or Comorbidity or Major Complication or Comorbidity; it defines a moderate-resource surgical cohort for inpatient payment. Proper assignment of this Diagnosis-Related Group matters because it determines the Medicare bundled payment level under the inpatient prospective payment system.

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    DRG 407 Overview

    DRG 407 covers inpatient admissions for pancreas, liver, and shunt surgical procedures when no Complication or Comorbidity or Major Complication or Comorbidity is coded. This Diagnosis-Related Group groups moderate-complexity hepatobiliary and pancreatic resections, drainage procedures, and shunt operations that do not carry additional coded complications, which affects relative resource use. It matters for Medicare payment because classification into this Diagnosis-Related Group determines bundled payment weights and hospital reimbursement under the inpatient prospective payment system. Accurate coding of procedures and comorbidities is essential to ensure claims are assigned to the appropriate Diagnosis-Related Group for payment purposes.

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    Clinical Trials

    • Acute perioperative interventions: randomized or controlled studies testing surgical techniques, intraoperative management strategies, or immediate perioperative protocols for patients undergoing pancreas, liver, or portal-systemic shunt procedures without major complications. These trials enroll adult surgical patients scheduled for resections (partial pancreatectomy, hepatic segmentectomy) or shunt operations, and study outcomes such as intraoperative blood loss, rates of postoperative bile leak or pancreatic fistula, and short-term morbidity within the hospitalization. Findings are relevant to surgeons and hospital payers because optimized perioperative care can reduce length of stay, resource utilization, and complication-related costs for cases classified under DRG 407.
    • Comparative effectiveness studies of procedural approaches and device adjuncts: pragmatic trials or registries comparing minimally invasive (laparoscopic/robotic) versus open approaches, or evaluating use of specific hemostatic agents, stapling technologies, or anastomotic techniques in low-complexity pancreas and liver procedures. These studies typically involve patients without major comorbid complications and assess operative time, conversion rates, readmission, and short-term functional recovery metrics; they help determine which approaches offer equivalent or superior outcomes at similar or lower cost. Payers and hospital systems use this evidence to inform procedure selection, allocation of capital equipment, and perioperative care pathways for DRG 407 cases.
    • Post-discharge outcomes and resource utilization studies: observational cohort studies and quality-improvement research tracking 30–90 day readmissions, outpatient complication management, and patient-reported outcomes after uncomplicated pancreas, liver, or shunt procedures. These studies focus on transitions of care—identifying predictors of early readmission, outpatient interventions that prevent return to hospital, and the impact of follow-up models on functional recovery. Results are important for case management and reimbursement stakeholders because reducing post-discharge complications and readmissions improves value of care for DRG 407 hospitalizations and influences bundled payment and quality metrics.

    Related Codes

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

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

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

    Pancreas, Liver and Shunt Procedures with CC: 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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