MDC 05 Diseases and disorders of the circulatory 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.
All patients who qualify for the subsection Other heart assist system implant will be automatically grouped into DRG 215 - OTHER HEART ASSIST SYSTEM IMPLANT.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 215 | OTHER HEART ASSIST SYSTEM IMPLANT | Medical |
All patients who qualify for the subsection Concomitant Aortic and Mitral Valve Procedures will be automatically grouped into DRG 212 - CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES.
View the requirements to qualify for this subsection.
| Aortic Valve Procedures | Mitral Valve Procedures | Concomitant Valve Procedures | DRG | Name | Type |
|---|---|---|---|---|---|
| Yes | Yes | Yes | 212 | CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES | Medical |
Patients who qualify for Cardiac valve and other major cardiothoracic 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 Coronary bypass will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| PTCA | Cardiac Catheterization | Open Ablation | MCC | DRG | Name | Type |
|---|---|---|---|---|---|---|
| Yes | n/a | n/a | Yes | 231 | CORONARY BYPASS WITH PTCA WITH MCC | Medical |
| Yes | n/a | n/a | No | 232 | CORONARY BYPASS WITH PTCA WITHOUT MCC | Medical |
| No | Yes | n/a | Yes | 233 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | Medical |
| No | n/a | Yes | Yes | 233 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC | Medical |
| No | Yes | n/a | No | 234 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | Medical |
| No | n/a | Yes | No | 234 | CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC | Medical |
| No | No | No | Yes | 235 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC | Medical |
| No | No | No | No | 236 | CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC | Medical |
Patients who qualify for Cardiac defibrillator implant will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Cardiac Catheterization | MCC | DRG | Name | Type |
|---|---|---|---|---|
| Yes | Yes | 275 | CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC | Medical |
| No | Yes | 276 | CARDIAC DEFIBRILLATOR IMPLANT WITH MCC | Medical |
| Yes | No | 277 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC | Medical |
| No | No | 277 | CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC | Medical |
Patients who qualify for Endovascular cardiac valve replacement and supplement procedures will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Endovascular Cardiac Valve Procedures | MCC | CC | DRG | Name | Type |
|---|---|---|---|---|---|
| Yes | Yes | n/a | 266 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC | Medical |
| Yes | No | Yes | 267 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | Medical |
| Yes | No | No | 267 | ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC | Medical |
Patients who qualify for Aortic and heart assist procedures except pulsation balloon 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 cardiothoracic procedures 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 | 228 | OTHER CARDIOTHORACIC PROCEDURES WITH MCC | Medical |
| No | 229 | OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC | Medical |
Patients who qualify for Other endovascular cardiac valve 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 major cardiovascular 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 | 270 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC | Medical |
| No | Yes | 271 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC | Medical |
| No | No | 272 | OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Amputation for circulatory system disorders except upper limb and toe 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 Permanent cardiac pacemaker implant 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 | 242 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC | Medical |
| No | Yes | 243 | PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC | Medical |
| No | No | 244 | PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC | Medical |
All patients who qualify for the subsection AICD generator procedures will be automatically grouped into DRG 245 - AICD GENERATOR PROCEDURES.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 245 | AICD GENERATOR PROCEDURES | Medical |
All patients who qualify for the subsection AICD lead procedures will be automatically grouped into DRG 265 - AICD LEAD PROCEDURES.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 265 | AICD LEAD PROCEDURES | Medical |
Patients who qualify for Percutaneous intracardiac 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 Coronary intravascular lithotripsy will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Intraluminal device | MCC | DRG | Name | Type |
|---|---|---|---|---|
| Yes | Yes | 323 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC | Medical |
| Yes | No | 324 | CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC | Medical |
| No | No | 325 | CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE | Medical |
Patients who qualify for Percutaneous cardiovascular procedures with intraluminal device will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Intraluminal device | MCC | 4+ Arteries/Intraluminal devices | DRG | Name | Type |
|---|---|---|---|---|---|
| Yes | No | Yes | 321 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES | Medical |
| Yes | Yes | No | 321 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES | Medical |
| Yes | No | No | 322 | PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC | Medical |
Patients who qualify for Percutaneous cardiovascular procedures without intraluminal device 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 Ultrasound accelerated and other thrombolysis 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 vascular 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 | 252 | OTHER VASCULAR PROCEDURES WITH MCC | Medical |
| No | Yes | 253 | OTHER VASCULAR PROCEDURES WITH CC | Medical |
| No | No | 254 | OTHER VASCULAR PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Upper limb and toe amputation for circulatory system 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 Cardiac pacemaker device replacement 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 | 258 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC | Medical |
| No | 259 | CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC | Medical |
Patients who qualify for Cardiac pacemaker revision except device replacement 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 Vein ligation and stripping will be automatically grouped into DRG 263 - VEIN LIGATION AND STRIPPING.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 263 | VEIN LIGATION AND STRIPPING | Medical |
All patients who qualify for the subsection Other circulatory system O.R. procedures will be automatically grouped into DRG 264 - OTHER CIRCULATORY SYSTEM O.R. PROCEDURES.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 264 | OTHER CIRCULATORY SYSTEM O.R. PROCEDURES | Medical |
Patients who qualify for Acute myocardial infarction will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| Discharged Alive | MCC | CC | DRG | Name | Type |
|---|---|---|---|---|---|
| Yes | Yes | n/a | 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | Medical |
| Yes | No | Yes | 281 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | Medical |
| Yes | No | No | 282 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | Medical |
| No | Yes | n/a | 283 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC | Medical |
| No | No | Yes | 284 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC | Medical |
| No | No | No | 285 | ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC | Medical |
Patients who qualify for Circulatory disorders except AMI, with cardiac catheterization 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 Acute and subacute endocarditis 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 | 288 | ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC | Medical |
| No | Yes | 289 | ACUTE AND SUBACUTE ENDOCARDITIS WITH CC | Medical |
| No | No | 290 | ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Heart failure and shock 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 | 291 | HEART FAILURE AND SHOCK WITH MCC | Medical |
| No | Yes | 292 | HEART FAILURE AND SHOCK WITH CC | Medical |
| No | No | 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | Medical |
Patients who qualify for Deep vein thrombophlebitis 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 | 294 | DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC | Medical |
| No | 295 | DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Cardiac arrest, unexplained 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 | 296 | CARDIAC ARREST, UNEXPLAINED WITH MCC | Medical |
| No | Yes | 297 | CARDIAC ARREST, UNEXPLAINED WITH CC | Medical |
| No | No | 298 | CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC | Medical |
Patients who qualify for Peripheral vascular 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 | 299 | PERIPHERAL VASCULAR DISORDERS WITH MCC | Medical |
| No | Yes | 300 | PERIPHERAL VASCULAR DISORDERS WITH CC | Medical |
| No | No | 301 | PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC | Medical |
Patients who qualify for Atherosclerosis 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 | 302 | ATHEROSCLEROSIS WITH MCC | Medical |
| No | 303 | ATHEROSCLEROSIS WITHOUT MCC | Medical |
Patients who qualify for Hypertension 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 | 304 | HYPERTENSION WITH MCC | Medical |
| No | 305 | HYPERTENSION WITHOUT MCC | Medical |
Patients who qualify for Cardiac congenital and valvular 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 Cardiac arrhythmia and conduction 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 | 308 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | Medical |
| No | Yes | 309 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | Medical |
| No | No | 310 | CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | Medical |
All patients who qualify for the subsection Angina pectoris will be automatically grouped into DRG 311 - ANGINA PECTORIS.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 311 | ANGINA PECTORIS | Medical |
All patients who qualify for the subsection Syncope and collapse will be automatically grouped into DRG 312 - SYNCOPE AND COLLAPSE.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 312 | SYNCOPE AND COLLAPSE | Medical |
All patients who qualify for the subsection Chest pain will be automatically grouped into DRG 313 - CHEST PAIN.
View the requirements to qualify for this subsection.
| DRG | Name | Type |
|---|---|---|
| 313 | CHEST PAIN | Medical |
Patients who qualify for Other circulatory system diagnoses 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 | 314 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC | Medical |
| No | Yes | 315 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC | Medical |
| No | No | 316 | OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC | Medical |