Cardiology Reimbursement Coding Fact Sheet

MS-DRGs

Medicare reimburses inpatient hospital services under the Inpatient Prospective Payment System (IPPS), which bases payment on Medicare Severity Diagnosis-Related Groups (MS-DRGs). The MS-DRG payment system groups similar diagnoses into a single payment level, and reimburses the hospital according to the extent of resources typically required to treat patients with similar diagnoses undergoing similar treatments. All services and supplies provided during the inpatient admission are bundled into a single MS-DRG reimbursement rate, regardless of the length of the inpatient stay, the intensity of treatments, or the number of procedures performed for the specific individual.

Common MS-DRGs for Coronary Procedures 

MSDRG	Description	2017 Mean Length of Stay	2017 FY Relative Weight	2017 Medicare FY Base Payment Rate
246	Percutaneous cardiovascular procedure with drug-eluting stent with MCC or 4+ vessels/stents	5.5	3.2525	$19,396
247	Percutaneous cardiovascular procedure with drug-eluting stent without MCC	2.7	2.1226	$12,658
248	Percutaneous cardiovascular procedure with non-drug-eluting stent with MCC or 4+ vessels/stents	6.3	3.0445	$18,156
249	Percutaneous cardiovascular procedure with non-drug-eluting stent without MCC	3.1	1.9358	$11,544
250	Percutaneous cardiovascular procedure without coronary artery stent with MCC	5.5	2.6299	$15,683
251	Percutaneous cardiovascular procedure without coronary artery stent without MCC	2.9	1.6868	$10,059
273	Percutaneous intracardiac procedures with MCC	8.0	3.6045	$21,495
274	Percutaneous intracardiac procedures without MCC	3.5	2.5303	$15,089
286	Circulatory disorders except acute myocardial infarction, with cardiac catheterization with MCC	7.0	2.2027	$13,136
287	Circulatory disorders except acute myocardial infarction, with cardiac catheterization without MCC	3.3	1.1693	$6,973

MCC = major complication or comorbidity 

CC = complication or comorbidity