Medicare DRGs Effective 10/1/2006 - 9/30/2007
Source: Federal Register Friday, August 18, 2006
[[Page 48180]]
TABLE 5.--LIST OF DIAGNOSIS-RELATED GROUPS (DRGs), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARTHIMETIC MEAN LENGTH OF STAY (LOS)
DRG	MDC	TYPE	DRG TITLE	RELATIVE WEIGHTS	GEOMETRIC MEAN LOS	ARITHMETIC MEAN LOS		FY 07 final rule post -acute care DRG		FY 07 final rule special pay DRG
1	01	SURG	CRANIOTOMY AGE >17 W CC	3.4651	7.3	9.8		Yes		No
2	01	SURG	CRANIOTOMY AGE >17 W/O CC	1.9525	3.4	4.4		Yes		No
3	01	SURG *	CRANIOTOMY AGE 0-17	2.0113	12.7	12.7		No		No
4	01	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
5	01	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
6	01	SURG	CARPAL TUNNEL RELEASE	0.7910	2.1	3.1		No		No
7	01	SURG	PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC	2.6609	6.5	9.4		Yes		Yes
8	01	SURG	PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC	1.5953	2.0	2.8		Yes		Yes
9	01	MED	SPINAL DISORDERS & INJURIES	1.3647	4.4	6.2		No		No
10	01	MED	NERVOUS SYSTEM NEOPLASMS W CC	1.2556	4.6	6.0		Yes		No
11	01	MED	NERVOUS SYSTEM NEOPLASMS W/O CC	0.8592	2.7	3.6		Yes		No
12	01	MED	DEGENERATIVE NERVOUS SYSTEM DISORDERS	0.9322	4.3	5.5		Yes		No
13	01	MED	MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA	0.8541	4.0	4.9		Yes		No
14	01	MED	INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION	1.2118	4.3	5.5		Yes		No
15	01	MED	NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT	0.9442	3.1	4.0		Yes		No
16	01	MED	NONSPECIFIC CEREBROVASCULAR DISORDERS W CC	1.3579	5.0	6.5		Yes		No
17	01	MED	NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC	0.7141	2.4	3.0		Yes		No
18	01	MED	CRANIAL & PERIPHERAL NERVE DISORDERS W CC	1.0038	4.1	5.2		Yes		No
19	01	MED	CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC	0.7194	2.7	3.4		Yes		No
20	01	MED	NO LONGER VALID	0.0000	0.0	0.0		No		No
21	01	MED	VIRAL MENINGITIS	1.4130	4.7	6.2		No		No
22	01	MED	HYPERTENSIVE ENCEPHALOPATHY	1.1652	3.9	5.0		No		No
23	01	MED	NONTRAUMATIC STUPOR & COMA	0.8015	3.0	3.9		No		No
24	01	MED	NO LONGER VALID	0.0000	0.0	0.0		No		No
25	01	MED	NO LONGER VALID	0.0000	0.0	0.0		No		No
26	01	MED	SEIZURE & HEADACHE AGE 0-17	1.0076	2.7	3.8		No		No
27	01	MED	TRAUMATIC STUPOR & COMA, COMA >1 HR	1.3499	3.1	4.7		No		No
28	01	MED	TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC	1.3357	4.2	5.7		Yes		No
29	01	MED	TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC	0.7401	2.6	3.2		Yes		No
30	01	MED  *	TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0-17	0.3402	*	*		No		No
31	01	MED	CONCUSSION AGE >17 W CC	0.9796	3.0	3.9		No		No
32	01	MED	CONCUSSION AGE >17 W/O CC	0.6408	1.9	2.3		No		No
33	01	MED  *	CONCUSSION AGE 0-17	0.2136	*	*		No		No
34	01	MED	OTHER DISORDERS OF NERVOUS SYSTEM W CC	1.0175	3.6	4.8		Yes		No
35	01	MED	OTHER DISORDERS OF NERVOUS SYSTEM W/O CC	0.6587	2.5	3.1		Yes		No
36	02	SURG	RETINAL PROCEDURES	0.8056	1.4	1.9		No		No
37	02	SURG	ORBITAL PROCEDURES	1.2064	2.7	4.1		No		No
38	02	SURG	PRIMARY IRIS PROCEDURES	0.6195	2.2	2.8		No		No
39	02	SURG	LENS PROCEDURES WITH OR WITHOUT VITRECTOMY	0.6461	1.6	2.1		No		No
40	02	SURG	EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17	1.0309	3.1	4.2		No		No
41	02	SURG *	EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0-17	0.3462	*	*		No		No
42	02	SURG	INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS	0.7717	1.7	2.5		No		No
43	02	MED	HYPHEMA	0.6192	2.4	3.0		No		No
44	02	MED	ACUTE MAJOR EYE INFECTIONS	0.7186	3.8	4.8		No		No
45	02	MED	NEUROLOGICAL EYE DISORDERS	0.7434	2.5	3.0		No		No
46	02	MED	OTHER DISORDERS OF THE EYE AGE >17 W CC	0.7915	3.2	4.2		No		No
47	02	MED	OTHER DISORDERS OF THE EYE AGE >17 W/O CC	0.5520	2.4	3.0		No		No
48	02	MED  *	OTHER DISORDERS OF THE EYE AGE 0-17	0.3050	*	*		No		No
49	03	SURG	MAJOR HEAD & NECK PROCEDURES	1.6684	3.2	4.5		No		No
50	03	SURG	SIALOADENECTOMY	0.8800	1.5	1.9		No		No
51	03	SURG	SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY	0.8788	1.9	2.7		No		No
52	03	SURG	CLEFT LIP & PALATE REPAIR	0.6498	1.3	1.5		No		No
53	03	SURG	SINUS & MASTOID PROCEDURES AGE >17	1.3540	2.5	4.0		No		No
54	03	SURG *	SINUS & MASTOID PROCEDURES AGE 0-17	0.4944	*	*		No		No
55	03	SURG	MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES	0.9652	1.9	2.9		No		No
56	03	SURG	RHINOPLASTY	0.8936	1.9	2.7		No		No
57	03	SURG	T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17	0.9975	2.1	3.3		No		No
58	03	SURG *	T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0-17	0.2807	*	*		No		No
59	03	SURG	TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17	0.6812	1.8	2.4		No		No
60	03	SURG *	TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0-17	0.2137	1.5	1.5		No		No
61	03	SURG	MYRINGOTOMY W TUBE INSERTION AGE >17	1.5987	3.7	6.1		No		No
62	03	SURG *	MYRINGOTOMY W TUBE INSERTION AGE 0-17	0.3027	1.3	1.3		No		No
63	03	SURG	OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES	1.3959	3.0	4.5		No		No
64	03	MED	EAR, NOSE, MOUTH & THROAT MALIGNANCY	1.2498	4.2	6.2		No		No
65	03	MED	DYSEQUILIBRIUM	0.6159	2.3	2.8		No		No
66	03	MED	EPISTAXIS	0.6280	2.4	3.1		No		No
67	03	MED	EPIGLOTTITIS	0.8242	2.8	3.7		No		No
68	03	MED	OTITIS MEDIA & URI AGE >17 W CC	0.6605	3.2	3.9		No		No
69	03	MED	OTITIS MEDIA & URI AGE >17 W/O CC	0.4910	2.5	3.0		No		No
70	03	MED	OTITIS MEDIA & URI AGE 0-17	0.3579	2.1	2.4		No		No
71	03	MED	LARYNGOTRACHEITIS	0.7758	3.4	4.4		No		No
72	03	MED	NASAL TRAUMA & DEFORMITY	0.7784	2.6	3.3		No		No
73	03	MED	OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17	0.8500	3.3	4.3		Yes		No
74	03	MED  *	OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0-17	0.3441	2.1	2.1		No		No
75	04	SURG	MAJOR CHEST PROCEDURES	3.0350	7.4	9.7		Yes		No
76	04	SURG	OTHER RESP SYSTEM O.R. PROCEDURES W CC	2.8386	8.2	10.7		Yes		No
77	04	SURG	OTHER RESP SYSTEM O.R. PROCEDURES W/O CC	1.1886	3.3	4.5		Yes		No
78	04	MED	PULMONARY EMBOLISM	1.2357	5.3	6.2		Yes		No
79	04	MED	RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC	1.6268	6.7	8.3		Yes		No
80	04	MED	RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC	0.8943	4.3	5.3		Yes		No
81	04	MED  *	RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0-17	1.5579	6.1	6.1		No		No
82	04	MED	RESPIRATORY NEOPLASMS	1.4121	5.1	6.8		Yes		No
83	04	MED	MAJOR CHEST TRAUMA W CC	1.0308	4.2	5.3		Yes		No
84	04	MED	MAJOR CHEST TRAUMA W/O CC	0.6028	2.6	3.1		Yes		No
85	04	MED	PLEURAL EFFUSION W CC	1.2459	4.7	6.2		Yes		No
86	04	MED	PLEURAL EFFUSION W/O CC	0.7132	2.7	3.5		Yes		No
87	04	MED	PULMONARY EDEMA & RESPIRATORY FAILURE	1.3838	4.9	6.4		No		No
88	04	MED	CHRONIC OBSTRUCTIVE PULMONARY DISEASE	0.8878	4.0	4.9		No		No
89	04	MED	SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC	1.0376	4.6	5.6		Yes		No
90	04	MED	SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC	0.6148	3.2	3.7		Yes		No
91	04	MED	SIMPLE PNEUMONIA & PLEURISY AGE 0-17	0.5598	2.5	3.4		No		No
92	04	MED	INTERSTITIAL LUNG DISEASE W CC	1.1979	4.8	6.0		Yes		No
93	04	MED	INTERSTITIAL LUNG DISEASE W/O CC	0.7437	3.0	3.8		Yes		No
94	04	MED	PNEUMOTHORAX W CC	1.1474	4.5	5.9		No		No
95	04	MED	PNEUMOTHORAX W/O CC	0.5871	2.7	3.4		No		No
96	04	MED	BRONCHITIS & ASTHMA AGE >17 W CC	0.7350	3.5	4.3		No		No
97	04	MED	BRONCHITIS & ASTHMA AGE >17 W/O CC	0.5429	2.8	3.4		No		No
98	04	MED	BRONCHITIS & ASTHMA AGE 0-17	0.5870	2.8	3.1		No		No
99	04	MED	RESPIRATORY SIGNS & SYMPTOMS W CC	0.7155	2.4	3.1		No		No
100	04	MED	RESPIRATORY SIGNS & SYMPTOMS W/O CC	0.5411	1.7	2.1		No		No
101	04	MED	OTHER RESPIRATORY SYSTEM DIAGNOSES W CC	0.8614	3.2	4.2		Yes		No
102	04	MED	OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC	0.5622	2.0	2.5		Yes		No
103	PRE	SURG	HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM	18.8653	22.2	35.4		No		No
104	05	SURG	CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD CATH	8.2903	12.8	15.1		Yes		No
105	05	SURG	CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH	6.0567	8.4	10.2		Yes		No
106	05	SURG	CORONARY BYPASS W PTCA	6.7383	9.3	10.9		No		No
107	05	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
108	05	SURG	OTHER CARDIOTHORACIC PROCEDURES	5.7544	8.8	10.9		Yes		No
109	05	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
110	05	SURG	MAJOR CARDIOVASCULAR PROCEDURES W CC	3.8064	5.4	8.1		No		No
111	05	SURG	MAJOR CARDIOVASCULAR PROCEDURES W/O CC	2.4879	2.3	3.1		No		No
112	05	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
113	05	SURG	AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE	3.2646	10.8	13.7		Yes		No
114	05	SURG	UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS	1.7527	6.6	8.7		Yes		No
115	05	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
116	05	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
117	05	SURG	CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT	1.3713	2.6	4.3		No		No
118	05	SURG	CARDIAC PACEMAKER DEVICE REPLACEMENT	1.6687	2.0	3.0		No		No
119	05	SURG	VEIN LIGATION & STRIPPING	1.4554	3.3	5.4		No		No
120	05	SURG	OTHER CIRCULATORY SYSTEM O.R. PROCEDURES	2.4173	6.0	9.2		Yes		No
121	05	MED	CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE	1.6166	5.2	6.5		Yes		No
122	05	MED	CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE	0.9621	2.7	3.4		No		No
123	05	MED	CIRCULATORY DISORDERS W AMI, EXPIRED	1.4902	2.9	4.7		No		No
124	05	MED	CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG	1.4099	3.3	4.4		No		No
125	05	MED	CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG	1.0530	2.1	2.7		No		No
126	05	MED	ACUTE & SUBACUTE ENDOCARDITIS	2.6653	9.0	11.2		Yes		No
127	05	MED	HEART FAILURE & SHOCK	1.0490	4.1	5.2		Yes		No
128	05	MED	DEEP VEIN THROMBOPHLEBITIS	0.7499	4.4	5.2		No		No
129	05	MED	CARDIAC ARREST, UNEXPLAINED	1.0118	1.6	2.5		No		No
130	05	MED	PERIPHERAL VASCULAR DISORDERS W CC	0.9712	4.3	5.5		Yes		No
131	05	MED	PERIPHERAL VASCULAR DISORDERS W/O CC	0.5755	3.1	3.7		Yes		No
132	05	MED	ATHEROSCLEROSIS W CC	0.6318	2.2	2.8		No		No
133	05	MED	ATHEROSCLEROSIS W/O CC	0.5494	1.8	2.1		No		No
134	05	MED	HYPERTENSION	0.6189	2.5	3.1		No		No
135	05	MED	CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC	0.9405	3.3	4.3		No		No
136	05	MED	CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O CC	0.6580	2.1	2.7		No		No
137	05	MED  *	CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0-17	0.8393	*	*		No		No
138	05	MED	CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC	0.8365	3.0	3.9		No		No
139	05	MED	CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC	0.5297	2.0	2.4		No		No
140	05	MED	ANGINA PECTORIS	0.5041	1.9	2.4		No		No
141	05	MED	SYNCOPE & COLLAPSE W CC	0.7633	2.7	3.4		No		No
142	05	MED	SYNCOPE & COLLAPSE W/O CC	0.6012	2.1	2.5		No		No
143	05	MED	CHEST PAIN	0.5637	1.7	2.1		No		No
144	05	MED	OTHER CIRCULATORY SYSTEM DIAGNOSES W CC	1.3381	4.3	5.9		Yes		No
145	05	MED	OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC	0.5834	2.0	2.6		Yes		No
146	06	SURG	RECTAL RESECTION W CC	2.7431	8.4	9.9		Yes		No
147	06	SURG	RECTAL RESECTION W/O CC	1.5124	4.9	5.6		Yes		No
148	06	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
149	06	SURG	MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC	1.4357	5.1	5.7		Yes		No
150	06	SURG	PERITONEAL ADHESIOLYSIS W CC	2.7871	8.7	10.8		Yes		No
151	06	SURG	PERITONEAL ADHESIOLYSIS W/O CC	1.2863	4.0	5.0		Yes		No
152	06	SURG	MINOR SMALL & LARGE BOWEL PROCEDURES W CC	1.8859	6.5	7.9		No		No
153	06	SURG	MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC	1.0983	4.4	4.9		No		No
154	06	SURG	NO LONGER VALID	0.0000	0.0	0.0		No		No
155	06	SURG	STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC	1.2948	3.0	4.0		Yes		No
156	06	SURG *	STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0-17	0.8644	6.0	6.0		No		No
157	06	SURG	ANAL & STOMAL PROCEDURES W CC	1.3430	4.1	5.8		Yes		No
158	06	SURG	ANAL & STOMAL PROCEDURES W/O CC	0.6577	2.1	2.7		Yes		No
159	06	SURG	HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC	1.4316	3.7	5.1		No		No
160	06	SURG	HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC	0.8675	2.2	2.7		No		No
161	06	SURG	INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC	1.2403	3.2	4.5		No		No
162	06	SURG	INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC	0.6916	1.7	2.1		No		No
163	06	SURG *	HERNIA PROCEDURES AGE 0-17	0.6809	2.1	2.1		No		No
164	06	SURG	APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC	2.1474	6.4	7.7		No		No
165	06	SURG	APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC	1.1843	3.4	4.0		No		No
166	06	SURG	APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC	1.4035	3.2	4.3		No		No
167	06	SURG	APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC	0.9001	1.8	2.1		No		No
168	03	SURG	MOUTH PROCEDURES W CC	1.2827	3.3	4.8		No		No
169	03	SURG	MOUTH PROCEDURES W/O CC	0.7679	1.8	2.3		No		No
170	06	SURG	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC	2.9921	7.8	10.9		Yes		No
171	06	SURG	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC	1.2242	3.1	4.2		Yes		No
172	06	MED	DIGESTIVE MALIGNANCY W CC	1.4293	5.1	6.9		Yes		No
173	06	MED	DIGESTIVE MALIGNANCY W/O CC	0.7645	2.7	3.6		Yes		No
174	06	MED	G.I. HEMORRHAGE W CC	1.0296	3.8	4.7		No		No
175	06	MED	G.I. HEMORRHAGE W/O CC	0.5808	2.4	2.9		No		No
176	06	MED	COMPLICATED PEPTIC ULCER	1.1275	4.0	5.1		Yes		No
177	06	MED	UNCOMPLICATED PEPTIC ULCER W CC	0.9333	3.6	4.4		No		No
178	06	MED	UNCOMPLICATED PEPTIC ULCER W/O CC	0.6900	2.6	3.1		No		No
179	06	MED	INFLAMMATORY BOWEL DISEASE	1.0804	4.5	5.8		No		No
180	06	MED	G.I. OBSTRUCTION W CC	0.9930	4.1	5.3		Yes		No
181	06	MED	G.I. OBSTRUCTION W/O CC	0.5784	2.8	3.3		Yes		No
182	06	MED	ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC	0.7853	3.2	4.1		No		No
183	06	MED	ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC	0.5841	2.3	2.8		No		No
184	06	MED	ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0-17	0.6192	2.5	3.7		No		No
185	03	MED	DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17	0.8886	3.3	4.5		No		No
186	03	MED  *	DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE 0-17	0.3294	2.9	2.9		No		No
187	03	MED	DENTAL EXTRACTIONS & RESTORATIONS	0.8421	3.1	4.2		No		No