MDC 07 Diseases and disorders of the hepatobiliary system and pancreas 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 Pancreas, liver and 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 | 405 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC | Medical |
| No | Yes | 406 | PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC | Medical |
| No | No | 407 | PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Biliary tract procedures except only cholecystectomy with or without C.D.E. 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 Cholecystectomy will be grouped into a DRG according to the logic below. View detailed requirements for qualifying for the DRGs in this subsection.
| C.D.E | Laparoscopic | MCC | CC | DRG | Name | Type |
|---|---|---|---|---|---|---|
| Yes | n/a | Yes | n/a | 411 | CHOLECYSTECTOMY WITH C.D.E. WITH MCC | Medical |
| Yes | n/a | No | Yes | 412 | CHOLECYSTECTOMY WITH C.D.E. WITH CC | Medical |
| Yes | n/a | No | No | 413 | CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC | Medical |
| No | No | Yes | n/a | 414 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC | Medical |
| No | No | No | Yes | 415 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC | Medical |
| No | No | No | No | 416 | CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC | Medical |
| No | Yes | Yes | No | 417 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC | Medical |
| No | Yes | No | Yes | 418 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC | Medical |
| No | Yes | No | No | 419 | LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC | Medical |
Patients who qualify for Hepatobiliary diagnostic 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 | 420 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC | Medical |
| No | Yes | 421 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC | Medical |
| No | No | 422 | HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC | Medical |
Patients who qualify for Other hepatobiliary or pancreas 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 Cirrhosis and alcoholic hepatitis 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 | 432 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC | Medical |
| No | Yes | 433 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC | Medical |
| No | No | 434 | CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC | Medical |
Patients who qualify for Malignancy of hepatobiliary system or pancreas 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 | 435 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC | Medical |
| No | Yes | 436 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC | Medical |
| No | No | 437 | MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC | Medical |
Patients who qualify for Disorders of pancreas except malignancy 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 | 438 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC | Medical |
| No | Yes | 439 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC | Medical |
| No | No | 440 | DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC | Medical |
Patients who qualify for Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis 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 Disorders of the biliary tract 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 | 444 | DISORDERS OF THE BILIARY TRACT WITH MCC | Medical |
| No | Yes | 445 | DISORDERS OF THE BILIARY TRACT WITH CC | Medical |
| No | No | 446 | DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC | Medical |