MS-DRG 218: Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC
Uncomplicated valve + cath
Typical indications
- Elective AVR/MVR
Common denial patterns
- Medical necessity
Appeal angles
Document echo, valve area, gradient meeting surgical threshold.
Context: how MS-DRGs work
MS-DRGs bundle hospital inpatient payment into a single amount per admission. Each DRG has a relative weight that multiplies the hospital's base rate to determine payment. 218 has relative weight 8.0142. Major Complication or Comorbidity (MCC) and Complication or Comorbidity (CC) secondary diagnoses can move a case to a higher-paying DRG within the same family.
Frequently asked questions
What is MS-DRG 218?
Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC. Uncomplicated valve + cath.
What are typical indications?
Elective AVR/MVR.
Why are claims under this DRG denied?
Medical necessity.
How do I appeal?
Document echo, valve area, gradient meeting surgical threshold.
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