DRAFT

ICD-10-CM/PCS MS-DRG v40.0 Definitions Manual

Pre-MDC

ECMO or tracheostomy with MV >96 hours or principal diagnosis except face, mouth and neck

ECMO	Tracheostomy	MV>96	PDX Exc Face, Mouth, Neck	Major O.R. Procedure	DRG
Yes	n/a	n/a	n/a	n/a	003
No	Yes	Yes		Yes	003
No	Yes		Yes	Yes	003
No	Yes	Yes		No	004
No	Yes		Yes	No	004

DRG 003 ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

DRG 004 TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

ECMO

OPERATING ROOM PROCEDURES

5A1522F

Extracorporeal Oxygenation, Membrane, Central

NON-OPERATING ROOM PROCEDURES

5A1522G*	Extracorporeal Oxygenation, Membrane, Peripheral Veno-arterial
5A1522H*	Extracorporeal Oxygenation, Membrane, Peripheral Veno-venous

TRACHEOSTOMY

OPERATING ROOM PROCEDURES

0B110F4	Bypass Trachea to Cutaneous with Tracheostomy Device, Open Approach
0B110Z4	Bypass Trachea to Cutaneous, Open Approach
0B114F4	Bypass Trachea to Cutaneous with Tracheostomy Device, Percutaneous Endoscopic Approach
0B114Z4	Bypass Trachea to Cutaneous, Percutaneous Endoscopic Approach

OR NON-OPERATING ROOM PROCEDURES

0B113F4*	Bypass Trachea to Cutaneous with Tracheostomy Device, Percutaneous Approach
0B113Z4*	Bypass Trachea to Cutaneous, Percutaneous Approach

MECHANICAL VENTILATION >96 HOURS

NON-OPERATING ROOM PROCEDURES

5A1955Z*

Respiratory Ventilation, Greater than 96 Consecutive Hours

PDX EXCEPT FACE, MOUTH & NECK

Principal Diagnosis not assigned to DRGs 011, 012 or 013

MAJOR O.R. PROCEDURE

Operating Room Procedures not listed in DRGs 987 thru 989

Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244
16 Mar 2022 17:08:13
CMS, code-revision=333, description-revision=1331

ECMO	Tracheostomy	MV>96	PDX Exc Face, Mouth, Neck	Major O.R. Procedure	DRG
Yes	n/a	n/a	n/a	n/a	003
No	Yes	Yes		Yes	003
No	Yes		Yes	Yes	003
No	Yes	Yes		No	004
No	Yes		Yes	No	004

ECMO	Tracheostomy	MV>96	PDX Exc Face, Mouth, Neck	Major O.R. Procedure	DRG
Yes	n/a	n/a	n/a	n/a	003
No	Yes	Yes		Yes	003
No	Yes		Yes	Yes	003
No	Yes	Yes		No	004
No	Yes		Yes	No	004

ECMO	Tracheostomy	MV>96	PDX Exc Face, Mouth, Neck	Major O.R. Procedure	DRG
Yes	n/a	n/a	n/a	n/a	003
No	Yes	Yes		Yes	003
No	Yes		Yes	Yes	003
No	Yes	Yes		No	004
No	Yes		Yes	No	004