MDC 08 Diseases & Disorders of the Musculoskeletal System & Connective Tissue 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 Combined Anterior and Posterior Spinal Fusion 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 | 453 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC | Medical |
| No | Yes | 454 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC | Medical |
| No | No | 455 | COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | Medical |
Patients who qualify for Spinal Fusion Except Cervical with Spinal Curvature / Malignancy / Infection or Extensive Fusions 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 Spinal Fusion Except Cervical 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 | 459 | SPINAL FUSION EXCEPT CERVICAL WITH MCC | Medical |
| No | 460 | SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | Medical |
Patients who qualify for Bilateral or Multiple Major Joint Procedures of Lower Extremity 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 Wound Debridement and Skin Graft Except Hand, for Musculoskeletal and Connective Tissue Disorders 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 Revision of Hip or Knee Replacement 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 | 466 | REVISION OF HIP OR KNEE REPLACEMENT WITH MCC | Medical |
| No | Yes | 467 | REVISION OF HIP OR KNEE REPLACEMENT WITH CC | Medical |
| No | No | 468 | REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC | Medical |
Patients who qualify for Hip replacement with Principal Diagnosis of Hip Fracture 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 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity 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 Cervical Spinal Fusion 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 | 471 | CERVICAL SPINAL FUSION WITH MCC | Medical |
| No | Yes | 472 | CERVICAL SPINAL FUSION WITH CC | Medical |
| No | No | 473 | CERVICAL SPINAL FUSION WITHOUT CC/MCC | Medical |
Patients who qualify for Amputation for Musculoskeletal System and Connective Tissue Disorders 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 Biopsies of Musculoskeletal System and Connective Tissue 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 Hip and Femur Procedures Except Major Joint 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 | 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | Medical |
| No | Yes | 481 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | Medical |
| No | No | 482 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC | Medical |
All patients who qualify for the subsection Major Joint and Limb Reattachment Procedures of Upper Extremity will be automatically grouped into DRG 483 - MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES.
View the requirements to qualify for this subsection.
Patients who qualify for Knee Procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| PDX of Infection | MCC | CC | CC or MCC | DRG | Name | Type |
|---|---|---|---|---|---|---|
| Yes | Yes | n/a | n/a | 485 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC | Medical |
| Yes | No | Yes | n/a | 486 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC | Medical |
| Yes | No | No | n/a | 487 | KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | Medical |
| No | n/a | n/a | Yes | 488 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC | Medical |
| No | n/a | n/a | No | 489 | KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC | Medical |
Patients who qualify for Back and Neck Procedures, Except Spinal Fusion, or Disc Devices/Neurostimulators will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Back & Neck Except Disc Devices | Disc Devices | Neurostimulator Combinations | MCC | CC | DRG | Name | Type |
|---|---|---|---|---|---|---|---|
| Yes | n/a | n/a | Yes | n/a | 518 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR | Medical |
| No | Yes | n/a | n/a | n/a | 518 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR | Medical |
| No | No | Yes | n/a | n/a | 518 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR | Medical |
| Yes | No | No | No | Yes | 519 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC | Medical |
| Yes | No | No | No | No | 520 | BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC | Medical |
Patients who qualify for Lower Extremity and Humerus Procedures Except Hip,Foot,Femur 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 Local Excision and Removal Internal Fixation Devices Except Hip and Femur 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 Local Excision and Removal Internal Fixation Devices of Hip and Femur 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 Soft Tissue 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 | 500 | SOFT TISSUE PROCEDURES WITH MCC | Medical |
| No | Yes | 501 | SOFT TISSUE PROCEDURES WITH CC | Medical |
| No | No | 502 | SOFT TISSUE PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Foot 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 | 503 | FOOT PROCEDURES WITH MCC | Medical |
| No | Yes | 504 | FOOT PROCEDURES WITH CC | Medical |
| No | No | 505 | FOOT PROCEDURES WITHOUT CC/MCC | Medical |
All patients who qualify for the subsection Major Thumb or Joint Procedures will be automatically grouped into DRG 506 - MAJOR THUMB OR JOINT PROCEDURES.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 506 | MAJOR THUMB OR JOINT PROCEDURES | Medical |
Patients who qualify for Major Shoulder or Elbow Joint Procedures 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 | 507 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC | Medical |
| No | 508 | MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC | Medical |
All patients who qualify for the subsection Arthroscopy will be automatically grouped into DRG 509 - ARTHROSCOPY.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 509 | ARTHROSCOPY | Medical |
Patients who qualify for Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures 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 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures 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 Other Musculoskeletal System and Connective Tissue O.R. Procedures 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 Fractures of Femur 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 | 533 | FRACTURES OF FEMUR WITH MCC | Medical |
| No | 534 | FRACTURES OF FEMUR WITHOUT MCC | Medical |
Patients who qualify for Fractures of Hip and Pelvis 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 | 535 | FRACTURES OF HIP AND PELVIS WITH MCC | Medical |
| No | 536 | FRACTURES OF HIP AND PELVIS WITHOUT MCC | Medical |
Patients who qualify for Sprains, Strains and Dislocations of Hip, Pelvis and Thigh 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 Osteomyelitis 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 | 539 | OSTEOMYELITIS WITH MCC | Medical |
| No | Yes | 540 | OSTEOMYELITIS WITH CC | Medical |
| No | No | 541 | OSTEOMYELITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy 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 Connective Tissue 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 | 545 | CONNECTIVE TISSUE DISORDERS WITH MCC | Medical |
| No | Yes | 546 | CONNECTIVE TISSUE DISORDERS WITH CC | Medical |
| No | No | 547 | CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC | Medical |
Patients who qualify for Septic Arthritis 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 | 548 | SEPTIC ARTHRITIS WITH MCC | Medical |
| No | Yes | 549 | SEPTIC ARTHRITIS WITH CC | Medical |
| No | No | 550 | SEPTIC ARTHRITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Medical Back Problems 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 | 551 | MEDICAL BACK PROBLEMS WITH MCC | Medical |
| No | 552 | MEDICAL BACK PROBLEMS WITHOUT MCC | Medical |
Patients who qualify for Bone Diseases and Arthropathies 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 | 553 | BONE DISEASES AND ARTHROPATHIES WITH MCC | Medical |
| No | 554 | BONE DISEASES AND ARTHROPATHIES WITHOUT MCC | Medical |
Patients who qualify for Signs and Symptoms of Musculoskeletal System and Connective Tissue 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 Tendonitis, Myositis and Bursitis 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 | 557 | TENDONITIS, MYOSITIS AND BURSITIS WITH MCC | Medical |
| No | 558 | TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC | Medical |
Patients who qualify for Aftercare, Musculoskeletal System and Connective Tissue 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 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh 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 Other Musculoskeletal System and Connective Tissue Diagnoses will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.