MDC 01 Diseases & Disorders of the Nervous System is broken down into subgroups, listed here from most to least resource intensive. If a patient received qualifying treatment in listed in more than one subgroup, the first one listed will determine the DRG assigned to the patient.
To determine if a patient qualifies for a subgroup, click on the subgroup name and check the requirements listed. Typically, each subgroup requires one of a serious of ICD-10-CM diagnostic codes or PCS codes to have been assigned to the patient.
To qualify for any subsection in this MDC, the patient's primary diagnostic code must be included in this list.
Patients who qualify for Intracranial Vascular Procedures with PDX Hemorrhage will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
Patients who qualify for Craniotomy will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
Major Device Implant or Acute Complex CNS PDX | Chemotherapy Implant | MCC | CC | DRG | Name | Type |
---|---|---|---|---|---|---|
n/a | Yes | n/a | n/a | 023 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH MCC OR CHEMOTHERAPY IMPLANT | Medical |
Yes | No | Yes | n/a | 023 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH MCC OR CHEMOTHERAPY IMPLANT | Medical |
Yes | No | No | n/a | 024 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITHOUT MCC | Medical |
No | No | Yes | n/a | 025 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC | Medical |
No | No | No | Yes | 026 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC | Medical |
No | No | No | No | 027 | CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Spinal Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | Spinal Neurostimulator Combinations | DRG | Name | Type |
---|---|---|---|---|---|
Yes | n/a | n/a | 028 | SPINAL PROCEDURES WITH MCC | Medical |
No | Yes | n/a | 029 | SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS | Medical |
No | No | Yes | 029 | SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS | Medical |
No | No | No | 030 | SPINAL PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Ventricular Shunt Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 031 | VENTRICULAR SHUNT PROCEDURES WITH MCC | Medical |
No | Yes | 032 | VENTRICULAR SHUNT PROCEDURES WITH CC | Medical |
No | No | 033 | VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Carotid Artery Stent Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 034 | CAROTID ARTERY STENT PROCEDURE WITH MCC | Medical |
No | Yes | 035 | CAROTID ARTERY STENT PROCEDURE WITH CC | Medical |
No | No | 036 | CAROTID ARTERY STENT PROCEDURE WITHOUT CC/MCC | Medical |
Patients who qualify for Extracranial Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 037 | EXTRACRANIAL PROCEDURES WITH MCC | Medical |
No | Yes | 038 | EXTRACRANIAL PROCEDURES WITH CC | Medical |
No | No | 039 | EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Peripheral and Cranial Nerve and Other Nervous System Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | Peripheral Neurostimulator Combinations | DRG | Name | Type |
---|---|---|---|---|---|
Yes | n/a | n/a | 040 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC | Medical |
No | Yes | n/a | 041 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR | Medical |
No | No | Yes | 041 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR | Medical |
No | No | No | 042 | PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Spinal Disorders and Injuries will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
CC or MCC | DRG | Name | Type |
---|---|---|---|
Yes | 052 | SPINAL DISORDERS AND INJURIES WITH CC/MCC | Medical |
No | 053 | SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC | Medical |
Patients who qualify for Nervous System Neoplasms will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 054 | NERVOUS SYSTEM NEOPLASMS WITH MCC | Medical |
No | 055 | NERVOUS SYSTEM NEOPLASMS WITHOUT MCC | Medical |
Patients who qualify for Degenerative Nervous System Disorders will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 056 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC | Medical |
No | 057 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | Medical |
Patients who qualify for Multiple Sclerosis and Cerebellar Ataxia will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 058 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC | Medical |
No | Yes | 059 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC | Medical |
No | No | 060 | MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC | Medical |
Patients who qualify for Acute Ischemic Stroke with Use of Thrombolytic Agent will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
Patients who qualify for Intracranial Hemorrhage or Cerebral Infarction will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | tPA in 24 hrs | DRG | Name | Type |
---|---|---|---|---|---|
Yes | n/a | n/a | 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | Medical |
No | Yes | n/a | 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | Medical |
No | No | Yes | 065 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | Medical |
No | No | No | 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | Medical |
Patients who qualify for Nonspecific CVA and Precerebral Occlusion without Infarction will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
All patients who qualify for the subsection Transient Ischemia will be automatically grouped into DRG 069 - TRANSIENT ISCHEMIA.
View the requirements to qualify for this subsection.
DRG | Name | Type |
---|---|---|
069 | TRANSIENT ISCHEMIA | Medical |
Patients who qualify for Nonspecific Cerebrovascular Disorders will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 070 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | Medical |
No | Yes | 071 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC | Medical |
No | No | 072 | NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC | Medical |
Patients who qualify for Cranial and Peripheral Nerve Disorders will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 073 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC | Medical |
No | 074 | CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC | Medical |
Patients who qualify for Viral Meningitis will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
CC or MCC | DRG | Name | Type |
---|---|---|---|
Yes | 075 | VIRAL MENINGITIS WITH CC/MCC | Medical |
No | 076 | VIRAL MENINGITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Hypertensive Encephalopathy will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 077 | HYPERTENSIVE ENCEPHALOPATHY WITH MCC | Medical |
No | Yes | 078 | HYPERTENSIVE ENCEPHALOPATHY WITH CC | Medical |
No | No | 079 | HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC | Medical |
Patients who qualify for Nontraumatic Stupor and Coma will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 080 | NONTRAUMATIC STUPOR AND COMA WITH MCC | Medical |
No | 081 | NONTRAUMATIC STUPOR AND COMA WITHOUT MCC | Medical |
Patients who qualify for Traumatic Stupor and Coma, Coma > 1 Hour will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 082 | TRAUMATIC STUPOR AND COMA, COMA >1 HOUR WITH MCC | Medical |
No | Yes | 083 | TRAUMATIC STUPOR AND COMA, COMA >1 HOUR WITH CC | Medical |
No | No | 084 | TRAUMATIC STUPOR AND COMA, COMA >1 HOUR WITHOUT CC/MCC | Medical |
Patients who qualify for Traumatic Stupor and Coma, Coma < 1 Hour will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 085 | TRAUMATIC STUPOR AND COMA, COMA <1 HOUR WITH MCC | Medical |
No | Yes | 086 | TRAUMATIC STUPOR AND COMA, COMA <1 HOUR WITH CC | Medical |
No | No | 087 | TRAUMATIC STUPOR AND COMA, COMA <1 HOUR WITHOUT CC/MCC | Medical |
Patients who qualify for Concussion will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 088 | CONCUSSION WITH MCC | Medical |
No | Yes | 089 | CONCUSSION WITH CC | Medical |
No | No | 090 | CONCUSSION WITHOUT CC/MCC | Medical |
Patients who qualify for Other Disorders of Nervous System will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | CC | DRG | Name | Type |
---|---|---|---|---|
Yes | n/a | 091 | OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC | Medical |
No | Yes | 092 | OTHER DISORDERS OF NERVOUS SYSTEM WITH CC | Medical |
No | No | 093 | OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC | Medical |
Patients who qualify for Bacterial and Tuberculous Infections of Nervous System will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
Patients who qualify for Non-Bacterial Infections of Nervous System Except Viral Meningitis will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
Patients who qualify for Seizures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 100 | SEIZURES WITH MCC | Medical |
No | 101 | SEIZURES WITHOUT MCC | Medical |
Patients who qualify for Headaches will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
MCC | DRG | Name | Type |
---|---|---|---|
Yes | 102 | HEADACHES WITH MCC | Medical |
No | 103 | HEADACHES WITHOUT MCC | Medical |