Summary & Overview
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.
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.