APPENDIX D, MS-DRG SURGICAL HIERARCHY BY MDC AND MS-DRG
Since patients can have multiple procedures related to their principal diagnosis during a particular
hospital stay, and a patient can be assigned to only one surgical class, the surgical classes in each MDC
are defined in a hierarchical order. Patients with multiple procedures are assigned to the highest surgical
class in the hierarchy to which one of the procedures is assigned. Thus, if a patient receives both a D&C
and a hysterectomy, the patient is assigned to the hysterectomy surgical class because a hysterectomy is
higher in the hierarchy than a D&C. Because of the surgical hierarchy, ordering of the surgical
procedures on the patient abstract or claim has no influence on the assignment of the surgical class and
the MS-DRG.
The surgical hierarchy for each MDC reflects the relative resource requirements of various surgical
procedures. In some cases a surgical class in the hierarchy is actually an MS-DRG. For example,
Arthroscopy is both a surgical class in the hierarchy and MS-DRG 509 in MDC 8, Diseases and Disorders
of the Musculoskeletal System and Connective Tissue. In other cases the surgical class in the hierarchy is
further partitioned based on other variables such as complications and comorbidities, or principal
diagnosis to form multiple MS-DRGs. As an example, in MDC 5, Diseases and Disorders of the Circulatory
System, the surgical class for permanent pacemaker implantation is divided into three MS-DRGs (242244) based on whether or not the patient had no CCs, a CC or an MCC.
Appendix D presents the surgical hierarchy for each MDC. Appendix D is organized by MDC with a list of
the surgical classes associated with that MDC listed in hierarchical order as well as the MS-DRGs that are
included in each surgical class. The names given to the surgical classes in the hierarchy correspond to
the names used in the MS-DRG logic tables and in the body of the Definitions Manual.
PRE MDC
Heart Transplant or Implant of Heart Assist System 001-002
ECMO or Tracheostomy with MV 96+ Hours or PDX Except Face, Mouth and Neck 003-004
Liver or Intestinal Transplant 005-006
Allogeneic Bone Marrow Transplant 014
Lung Transplant 007
Simultaneous Pancreas/Kidney Transplant 008
Autologous Bone Marrow Transplant 016-017
Pancreas Transplant 010
Tracheostomy for Face, Mouth and Neck Diagnoses 011-013
MULTIPLE SIGNIFICANT TRAUMA 955-959
HIV INFECTION 969-970
MDC 01, DISEASES AND DISORDERS OF THE NERVOUS SYSTEM
Intracranial Vascular Procedures with PDX Hemorrhage 020-022
Craniotomy 023-027
Spinal Procedures 028-030
Ventricular Shunt Procedures 031-033
Carotid Artery Stent Procedures 034-036
Extracranial Procedures 037-039
Peripheral and Cranial Nerve and Other Nervous System Procedures 040-042
MDC 02, DISEASES AND DISORDERS OF THE EYE
Orbital Procedures 113-114
Extraocular Procedures Except Orbit 115
Intraocular Procedures 116-117
MDC 03, DISEASES AND DISORDERS OF THE EAR, NOSE, MOUTH AND THROAT
Major Head and Neck Procedures 129-130
Cranial/facial Procedures 131-132
Other Ear, Nose, Mouth and Throat O.R. Procedures 133-134
Sinus and Mastoid Procedures 135-136
Mouth Procedures 137-138
Salivary Gland Procedures 139
MDC 04, DISEASES AND DISORDERS OF THE RESPIRATORY SYSTEM
Major Chest Procedures 163-165
Other Respiratory System O.R. Procedures 166-168
MDC 05, DISEASES AND DISORDERS OF THE CIRCULATORY SYSTEM
Other Heart Assist System Implant 215
Cardiac Valve and Other Major Cardiothoracic Procedures 216-221
Cardiac Defibrillator Implant 222-227
Other Cardiothoracic Procedures 228-230
Coronary Bypass 231-236
Major Cardiovascular Procedures 237-238
Amputation for Circulatory System Disorders Except Upper Limb and Toe 239-241
Permanent Cardiac Pacemaker Implant 242-244
AICD Generator Procedures 245
AICD Lead Procedures 265
Percutaneous Cardiovascular Procedures with Coronary Artery Stent 246-249
Percutaneous Cardiovasc Procedures without Coronary Artery Stent 250-251
Other Vascular Procedures 252-254
Upper Limb and Toe Amputation for Circulatory System Disorders 255-257
Cardiac Pacemaker Device Replacement 258-259
Cardiac Pacemaker Revision Except Device Replacement 260-262
Vein Ligation and Stripping 263
Other Circulatory System O.R. Procedures 264
MDC 06, DISEASES AND DISORDERS OF THE DIGESTIVE SYSTEM
Stomach, Esophageal and Duodenal Procedures 326-328
Major Small and Large Bowel Procedures 329-331
Rectal Resection 332-334
Peritoneal Adhesiolysis 335-337
Appendectomy 338-343
Minor Small and Large Bowel Procedures 344-346
Anal and Stomal Procedures 347-349
Inguinal and Femoral Hernia Procedures 350-352
Hernia Procedures Except Inguinal and Femoral 353-355
Other Digestive System O.R. Procedures 356-358
MDC 07, DISEASES AND DISORDERS OF THE HEPATOBILIARY SYSTEM AND PANCREAS
Pancreas, Liver and Shunt Procedures 405-407
Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. 408-410
Cholecystectomy 411-419
Hepatobiliary Diagnostic Procedures 420-422
Other Hepatobiliary or Pancreas O.R. Procedures 423-425
MDC 08, DISEASES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE
Combined Anterior/Posterior Spinal Fusion 453-455
Spinal Fusion Except Cervical with Spinal Curvature / Malignancy / Infection or 9+ Fusions 456-458
Spinal Fusion Except Cervical 459-460
Bilateral or Multiple Major Joint Procedures of Lower Extremity 461-462
Wound Debridement and Skin Graft Except Hand, for Musculoskeletal and Connective Tissue Disorders
463-465
Revision of Hip or Knee Replacement 466-468
Major Joint Replacement or Reattachment of Lower Extremity 469-470
Cervical Spinal Fusion 471-473
Amputation for Musculoskeletal System and Connective Tissue Disorders 474-476
Biopsies of Musculoskeletal System and Connective Tissue 477-479
Hip and Femur Procedures Except Major Joint 480-482
Major Joint and Limb Reattachment Procedures of Upper Extremity 483-484
Knee Procedures 485-489
Back and Neck Procedures, Except Spinal Fusion, or Disc Devices/Neurostimulators 490-491
Lower Extremity and Humerus Procedures Except Hip,Foot,Femur 492-494
Local Excision and Removal Int Fix Devices Except Hip and Femur 495-497
Local Excision and Removal Int Fix Devices of Hip and Femur 498-499
Soft Tissue Procedures 500-502
Foot Procedures 503-505
Major Thumb or Joint Procedures 506
Major Shoulder or Elbow Joint Procedures 507-508
Arthroscopy 509
Shoulder,Elbow or Forearm Procedures, Except Major Joint Procedures 510-512
Hand or Wrist Procedures, Except Major Thumb or Joint Procedures 513-514
Other Musculoskeletal System and Connective Tissue O.R. Procedures 515-517
MDC 09, DISEASES AND DISORDERS OF THE SKIN, SUBCUTANEOUS TISSUE AND BREAST
Skin Graft for/exc Skin Ulcer or Cellulitis 573-578
Skin Debridment 570-572
Other Skin, Subcutaneous Tissue and Breast Procedures 579-581
Mastectomy for Malignancy 582-583
Breast Biopsy, Local Excision and Other Breast Procedures 584-585
MDC 10, ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES AND DISORDERS
Amputation of Lower Limb for Endocrine,Nutritional, and Metabolic Disorders 616-618
O.R. Procedures for Obesity 619-621
Skin Grafts and Wound Debridment for Endocrine, Nutritional and Metabolic Disorders 622-624
Adrenal and Pituitary Procedures 614-615
Thyroid, Parathyroid and Thyroglossal Procedures 625-627
Other Endocrine, Nutritional and Metabolic O.R. Procedures 628-630
MDC 11, DISEASES AND DISORDERS OF THE KIDNEY AND URINARY TRACT
Kidney Transplant 652
Major Bladder Procedures 653-655
Kidney and Ureter Procedures 656-661
Minor Bladder Procedures 662-664
Prostatectomy 665-667
Transurethral Procedures 668-670
Urethral Procedures 671-672
Other Kidney and Urinary Tract Procedures 673-675
MDC 12, DISEASES AND DISORDERS OF THE MALE REPRODUCTIVE SYSTEM
Major Male Pelvic Procedures 707-708
Penis Procedures 709-710
Testes Procedures 711-712
Transurethral Prostatectomy 713-714
Other Male Reproductive System O.R. Procedures 715-718
MDC 13, DISEASES AND DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM
Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy 734-735
Uterine and Adnexal Procedures for Malignancy 736-741
Uterine and Adnexal Procedures for Non-Malignancy 742-743
D&C, Conization, Laparascopy and Tubal Interruption 744-745
Vagina, Cervix and Vulva Procedures 746-747
Female Reproductive System Reconstructive Procedures 748
Other Female Reproductive System O.R. Procedures 749-750
MDC 14, PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
Cesarean Section 765-766
Vaginal Delivery with O.R. Procedure 767-768
Postpartum and Post Abortion Diagnoses with O.R. Procedure 769
Abortion with D&C, Aspiration Curettage or Hysterotomy 770
MDC 15, NEWBORNS AND OTHER NEONATES WITH CONDITION ORIGINATING IN PERINATAL PERIOD
None
MDC 16, DISEASES AND DISORDERS OF BLOOD, BLOOD FORMING ORGANS, IMMUNOLOGICAL
DISORDERS
Splenectomy 799-801
Other O.R. Procedures of the Blood and Blood Forming Organs 802-804
MDC 17, MYELOPROLIFERATIVE DISEASES AND DISORDERS, POORLY DIFFERENTIATED NEOPLASM
Lymphoma and Leukemia with Major O.R. Procedure 820-822
Lymphoma and Non-Acute Leukemia with Other O.R. Procedure 823-825
Myeloproliferative Disorders or Poorly Differentiated Neoplasms 826-830
MDC 18, INFECTIOUS AND PARASITIC DISEASES, SYSTEMIC OR UNSPECIFIED SITES
Postoperative or Post-Traumatic Infections with O.R. Procedure 856-858
Infectious and Parasitic Diseases with O.R. Procedure 853-855
MDC 19, MENTAL DISEASES AND DISORDERS
O.R. Procedure with Principal Diagnoses of Mental Illness 876
MDC 20, ALCOHOL/DRUG USE AND ALCOHOL/DRUG INDUCED ORGANIC MENTAL DISORDERS
None
MDC 21, INJURIES, POISONINGS AND TOXIC EFFECTS OF DRUGS
Wound Debridements for Injuries 901-903
Skin Grafts for Injuries 904-905
Hand Procedures for Injuries 906
Other O.R. Procedures for Injuries 907-909
MDC 22, BURNS
Extensive Burns or Full Thickness Burns with MV 96+ Hours with Skin Graft 927
Full Thickness Burns with Skin Graft 928-929
MDC 23, FACTORS INFLUENCING HEALTH STATUS AND OTHER CONTACTS WITH HEALTH SERVICES
O.R. Procedures with Diagnoses of Other Contact with Health Services 939-941
MDC 24, MULTIPLE SIGNIFICANT TRAUMA
Craniotomy for Multiple Significant Trauma 955
Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma 956
Other O.R. Procedures for Multiple Significant Trauma 957-959
MDC 25, HUMAN IMMUNODEFICIENCY VIRUS INFECTIONS
HIV with Extensive O.R. Procedure 969-970