MS-DRG v36 (FY 2019) MDC 01 | Turquoise Health MS-DRG Manual

Enhanced MS-DRG Definitions Manual

MS-DRG v36 (FY 2019) Definitions Manual • MDC 01

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.

MDC 01 Assignment of Diagnosis Codes

To qualify for any subsection in this MDC, the patient's primary diagnostic code must be included in this list.

Intracranial Vascular Procedures with PDX Hemorrhage

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.

MCC	CC	DRG	Name	Type
Yes	n/a	020	INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH MCC	Medical
No	Yes	021	INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH CC	Medical
No	No	022	INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT CC/MCC	Medical

Craniotomy with Major Device Implant or Acute Complex CNS PDX

Patients who qualify for Craniotomy with Major Device Implant or Acute Complex CNS PDX 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	PDX Epilepsy w/ Neurostim	MCC	DRG	Name	Type
n/a	Yes	No	n/a	023	CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR	Medical
Yes	No	No	Yes	023	CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR	Medical
n/a	No	Yes	n/a	023	CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR	Medical
Yes	No	No	No	024	CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITHOUT MCC	Medical

Craniotomy and Endovascular Intracranial Procedures

Patients who qualify for Craniotomy and Endovascular Intracranial 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	No	025	CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC	Medical
No	Yes	026	CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC	Medical
No	No	027	CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC	Medical

Spinal Procedures

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

Ventricular Shunt Procedures

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

Carotid Artery Stent Procedures

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

Extracranial Procedures

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

Peripheral and Cranial Nerve and Other Nervous System Procedures

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

Spinal Disorders and Injuries

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

Nervous System Neoplasms

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

Degenerative Nervous System Disorders

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

Multiple Sclerosis and Cerebellar Ataxia

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

Ischemic Stroke with Use of Thrombolytic Agent

Patients who qualify for 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.

MCC	CC	DRG	Name	Type
Yes	n/a	061	ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC	Medical
No	Yes	062	ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC	Medical
No	No	063	ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC	Medical

Intracranial Hemorrhage or Cerebral Infarction

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

Nonspecific CVA and Precerebral Occlusion without Infarction

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.

MCC	DRG	Name	Type
Yes	067	NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC	Medical
No	068	NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC	Medical

Transient Ischemia

All patients who qualify for the subsection Transient Ischemia will be automatically grouped into DRG 069 - TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC.

View the requirements to qualify for this subsection.

DRG	Name	Type
069	TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC	Medical

Nonspecific Cerebrovascular Disorders

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

Cranial and Peripheral Nerve Disorders

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

Viral Meningitis

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

Hypertensive Encephalopathy

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

Nontraumatic Stupor and Coma

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

Traumatic Stupor and Coma, Coma > 1 Hour

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

Traumatic Stupor and Coma, Coma < 1 Hour

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

Concussion

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

Other Disorders of Nervous System

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

Bacterial and Tuberculous Infections of Nervous System

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.

MCC	CC	DRG	Name	Type
Yes	n/a	094	BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC	Medical
No	Yes	095	BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC	Medical
No	No	096	BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC	Medical

Non-Bacterial Infections of Nervous System Except Viral Meningitis

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.

MCC	CC	DRG	Name	Type
Yes	n/a	097	NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC	Medical
No	Yes	098	NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC	Medical
No	No	099	NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC	Medical

Seizures

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

Headaches

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

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