08

Diseases and Disorders of the Musculoskeletal System and Connective Tissue

Surgical hierarchy

In the order the grouper applies them, highest first. A patient with several procedures is assigned to the highest surgical class one of them belongs to, so this ordering decides the DRG, not the order procedures appear on the claim.

1. 1 Extensive or Complex Spinal Fusion Procedures Except Cervical
   • 523 Extensive or Complex Spinal Fusion Procedures Except Cervical with MCC 13.7443
   • 524 Extensive or Complex Spinal Fusion Procedures Except Cervical with CC 9.8365
   • 525 Extensive or Complex Spinal Fusion Procedures Except Cervical without CC/MCC 7.2982
2. 2 Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical
   • 426 Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC 9.9191
   • 427 Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC 6.7049
   • 428 Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC 5.9222
3. 3 Combined Anterior and Posterior Cervical Spinal Fusion
   • 429 Combined Anterior and Posterior Cervical Spinal Fusion with MCC 8.8363
   • 430 Combined Anterior and Posterior Cervical Spinal Fusion without MCC 5.8956
4. 4 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection
   • 456 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection with MCC 7.6244
   • 457 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection with CC 5.3668
   • 458 Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or Infection without CC/MCC 4.0388
5. 5 Multiple Level Spinal Fusion Except Cervical
   • 447 Multiple Level Spinal Fusion Except Cervical with MCC 6.9667
   • 448 Multiple Level Spinal Fusion Except Cervical without MCC 4.3506
6. 6 Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical
   • 402 Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical 4.0967
7. 7 Revision of Hip or Knee Prosthesis
   • 449 Revision of Hip or Knee Prosthesis 3.2995
8. 8 Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection
   • 403 Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection with MCC or Insertion of Antibiotic-eluting Bone Void Filler 5.0061
   • 404 Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection without MCC 3.2513
9. 9 Single Level Spinal Fusion Except Cervical
   • 450 Single Level Spinal Fusion Except Cervical with MCC 5.2340
   • 451 Single Level Spinal Fusion Except Cervical without MCC 3.2600
10. 10 Cervical Spinal Fusion
    • 471 Cervical Spinal Fusion with MCC 4.9370
    • 472 Cervical Spinal Fusion with CC 2.9811
    • 473 Cervical Spinal Fusion without CC/MCC 2.4518
11. 11 Wound Debridement or Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders
    • 463 Wound Debridement or Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders with MCC or Insertion of Antibiotic-eluting Bone Void Filler 5.1296
    • 464 Wound Debridement or Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders with CC 3.1764
    • 465 Wound Debridement or Skin Graft Except Hand for Musculoskeletal and Connective Tissue Disorders without CC/MCC 2.4822
12. 12 Bilateral or Multiple Major Joint Procedures of Lower Extremity
    • 461 Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC 4.9707
    • 462 Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC 2.8540
13. 13 Local Excision and Removal of Internal Fixation Devices of Hip and Femur
    • 498 Local Excision and Removal of Internal Fixation Devices of Hip and Femur with CC/MCC 3.1881
    • 499 Local Excision and Removal of Internal Fixation Devices of Hip and Femur without CC/MCC 2.1676
14. 14 Major Joint or Limb Reattachment Procedures of Upper Extremities
    • 483 Major Joint or Limb Reattachment Procedures of Upper Extremities 2.8966
15. 15 Amputation for Musculoskeletal System and Connective Tissue Disorders
    • 474 Amputation for Musculoskeletal System and Connective Tissue Disorders with MCC or Insertion of Antibiotic-eluting Bone Void Filler 4.2144
    • 475 Amputation for Musculoskeletal System and Connective Tissue Disorders with CC 2.2249
    • 476 Amputation for Musculoskeletal System and Connective Tissue Disorders without CC/MCC 1.1360
16. 16 Biopsies of Musculoskeletal System and Connective Tissue
    • 477 Biopsies of Musculoskeletal System and Connective Tissue with MCC or Insertion of Antibiotic-eluting Bone Void Filler 3.4040
    • 478 Biopsies of Musculoskeletal System and Connective Tissue with CC 2.4337
    • 479 Biopsies of Musculoskeletal System and Connective Tissue without CC/MCC 1.8542
17. 17 Lower Extremity and Humerus Procedures Except Hip, Foot and Femur
    • 492 Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with MCC or Insertion of Antibiotic-eluting Bone Void Filler 3.6914
    • 493 Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with CC 2.5528
    • 494 Lower Extremity and Humerus Procedures Except Hip, Foot and Femur without CC/MCC 2.0257
18. 18 Hip Replacement with Principal Diagnosis of Hip Fracture
    • 521 Hip Replacement with Principal Diagnosis of Hip Fracture with MCC 2.8515
    • 522 Hip Replacement with Principal Diagnosis of Hip Fracture without MCC 2.1158
19. 19 Hip and Femur Procedures Except Major Joint
    • 480 Hip and Femur Procedures Except Major Joint with MCC or Insertion of Antibiotic-eluting Bone Void Filler 2.9204
    • 481 Hip and Femur Procedures Except Major Joint with CC 2.1265
    • 482 Hip and Femur Procedures Except Major Joint without CC/MCC 1.6397
20. 20 Back and Neck Procedures Except Spinal Fusion or Disc Device or Neurostimulator
    • 518 Back and Neck Procedures Except Spinal Fusion with MCC or Disc Device or Neurostimulator 3.7343
    • 519 Back and Neck Procedures Except Spinal Fusion with CC 2.0358
    • 520 Back and Neck Procedures Except Spinal Fusion without CC/MCC 1.5557
21. 21 Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures
    • 510 Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with MCC 3.1294
    • 511 Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures with CC 2.1181
    • 512 Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures without CC/MCC 1.7025
22. 22 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity or Total Ankle Replacement
    • 469 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity with MCC or Total Ankle Replacement 3.1085
    • 470 Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC 1.9563
23. 23 Soft Tissue Procedures
    • 500 Soft Tissue Procedures with MCC 3.3628
    • 501 Soft Tissue Procedures with CC 1.8663
    • 502 Soft Tissue Procedures without CC/MCC 1.4332
24. 24 Knee Procedures with Principal Diagnosis of Infection
    • 400 Knee Procedures with Principal Diagnosis of Infection 2.0248
25. 25 Foot Procedures
    • 503 Foot Procedures with MCC 2.7742
    • 504 Foot Procedures with CC 1.7755
    • 505 Foot Procedures without CC/MCC 1.7755
26. 26 Knee Procedures without Principal Diagnosis of Infection
    • 488 Knee Procedures without Principal Diagnosis of Infection with CC/MCC 2.2211
    • 489 Knee Procedures without Principal Diagnosis of Infection without CC/MCC 1.3122
27. 27 Local Excision and Removal of Internal Fixation Devices Except Hip and Femur
    • 495 Local Excision and Removal of Internal Fixation Devices Except Hip and Femur with MCC 3.3375
    • 496 Local Excision and Removal of Internal Fixation Devices Except Hip and Femur with CC 1.7779
    • 497 Local Excision and Removal of Internal Fixation Devices Except Hip and Femur without CC/MCC 1.1708
28. 28 Major Shoulder or Elbow Joint Procedures
    • 507 Major Shoulder or Elbow Joint Procedures with CC/MCC 1.8575
    • 508 Major Shoulder or Elbow Joint Procedures without CC/MCC 1.3630
29. 29 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures
    • 513 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with CC/MCC 1.5215
    • 514 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without CC/MCC 1.0202
30. 30 Major Thumb or Joint Procedures
    • 506 Major Thumb or Joint Procedures 1.2143
31. 31 Other Musculoskeletal System and Connective Tissue O.R. Procedures
    • 515 Other Musculoskeletal System and Connective Tissue O.R. Procedures with MCC 3.1873
    • 516 Other Musculoskeletal System and Connective Tissue O.R. Procedures with CC 2.1181
    • 517 Other Musculoskeletal System and Connective Tissue O.R. Procedures without CC/MCC 1.5727

Medical DRGs

34 medical DRGs. The surgical hierarchy does not apply to these, so they are listed by number.

• 533 Fractures of Femur with MCC 1.4649
• 534 Fractures of Femur without MCC 0.8403
• 535 Fractures of Hip and Pelvis with MCC 1.2728
• 536 Fractures of Hip and Pelvis without MCC 0.8070
• 537 Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh with CC/MCC 0.9152
• 538 Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without CC/MCC 0.7109
• 539 Osteomyelitis with MCC 1.9385
• 540 Osteomyelitis with CC 1.3079
• 541 Osteomyelitis without CC/MCC 0.8297
• 542 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with MCC 1.7211
• 543 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy with CC 1.0060
• 544 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy without CC/MCC 0.7406
• 545 Connective Tissue Disorders with MCC 2.3892
• 546 Connective Tissue Disorders with CC 1.1745
• 547 Connective Tissue Disorders without CC/MCC 0.7526
• 548 Septic Arthritis with MCC 1.9519
• 549 Septic Arthritis with CC 1.1435
• 550 Septic Arthritis without CC/MCC 0.8591
• 551 Medical Back Problems with MCC 1.6358
• 552 Medical Back Problems without MCC 0.9584
• 553 Bone Diseases and Arthropathies with MCC 1.2494
• 554 Bone Diseases and Arthropathies without MCC 0.8331
• 555 Signs and Symptoms of Musculoskeletal System and Connective Tissue with MCC 1.2913
• 556 Signs and Symptoms of Musculoskeletal System and Connective Tissue without MCC 0.8211
• 557 Tendonitis, Myositis and Bursitis with MCC 1.4890
• 558 Tendonitis, Myositis and Bursitis without MCC 0.8875
• 559 Aftercare, Musculoskeletal System and Connective Tissue with MCC 1.8088
• 560 Aftercare, Musculoskeletal System and Connective Tissue with CC 1.1238
• 561 Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC 0.8258
• 562 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCC 1.3980
• 563 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCC 0.8985
• 564 Other Musculoskeletal System and Connective Tissue Diagnoses with MCC 1.4908
• 565 Other Musculoskeletal System and Connective Tissue Diagnoses with CC 0.9783
• 566 Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC 0.7378