ICD-10-PCS CODE/CODE RANGE DESCRIPTION A REIMBURSEMENT HOSPITAL (FACILITY) INPATIENT OVERVIEW
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1 Surgical Bypass Grafting with Other Than Vein for Peripheral Arterial Disease Coverage, Coding and Reimbursement Overview Hospital (Facility) Inpatient 2019 Edition All Reimbursement Amounts are Listed at National Unadjusted Medicare Rates and Do Not Include the 2% Sequestration Reduction HOSPITAL (FACILITY) INPATIENT OVERVIEW GREAT HEART AND VESSELS Bypass Descending Thoracic Aorta to Subclavian/Carotid with Synthetic Bypass Ascending/Arch Thoracic Aorta to Subclavian/Carotid with Synthetic MS-DRG B Relative Weight C Rate D 021W0JB, 021W0JD $19, $10, $6, $30, X0JB, 021X0JD $21, $15,985 UPPER ARTERIES Bypass Innominate Artery to Right/Left/Bilateral Upper/Lower Arm/Leg Artery 03120J JC $19,903 with Synthetic $15, $11,051 Bypass Right Subclavian Artery to Right/Left/Bilateral Upper/Lower Arm/Leg 03130J JC Artery with Synthetic Bypass Left Subclavian Artery to Right/Left/Bilateral Upper/Lower Arm/Leg with Synthetic Bypass Right Subclavian Artery to Right/Left Extracranial Artery Artery with Synthetic Bypass Left Subclavian Artery to Right/Left Extracranial Artery Artery with Synthetic Bypass Right Axillary Artery to Right/Left/Bilateral Upper/Lower Arm/Leg/ Abdominal Artery with Synthetic Bypass Left Axillary Artery to Right/Left/Bilateral Upper/Lower Arm/Leg/ Abdominal Artery with Synthetic Bypass Right Brachial Artery to Right Upper/Lower Arm Artery with Synthetic 03140J JC 03130JJ, 03130JK 03140JJ, 03140JK 03150J JC, 03150JT 03160J JC, 03160JT 03170J J3
2 MS-DRG B Relative Weight C Rate D UPPER ARTERIES Bypass Left Brachial Artery to Left Upper/Lower Arm Artery with 03180J J $19,903 Synthetic $15, $11,051 Bypass Right Ulnar Artery to Right Lower Arm Artery with Synthetic 03190J3 Bypass Left Ulnar Artery to Left Lower Arm Artery with Synthetic Bypass Right Radial Artery to Right Lower Arm Artery with Synthetic Bypass Left Radial Artery to Right Lower Arm Artery with Synthetic 031A0J4 031B0J3 031C0J4 Bypass Right Common Carotid Artery to Right, Left Extracranial/ 031H0JJ-031H0JY $19,597 Upper Artery with Synthetic $10, $6, $19,903 Bypass Left Common Carotid Artery to Right, Left Extracranial/ 031J0JJ- 031J0JY $15,839 Upper Artery with Synthetic $11,051 Bypass Right Internal Carotid Artery to Right/Left Extracranial Artery with Synthetic Bypass Left Internal Carotid Artery to Right/Left Extracranial Artery with Synthetic Bypass Right External Carotid Artery to Right/Left Extracranial Artery with Synthetic Bypass Left External Carotid Artery to Right/Left Extracranial Artery with Synthetic 031K0JJ-031K0JK 031L0JJ-031L0JK 031M0JJ-031M0JK 031N0JJ-031N0JK
3 MS-DRG B Relative Weight C LOWER ARTERIES Bypass Abdominal Aorta to Abdominal Aorta/Celiac/Mesenteric/ 04100J JR $30,904 Right, Left, Bilateral Renal/Right, Left, Bilateral Common Iliac/ $21,331 Right, Left, Bilateral Internal Iliac/Right, Left, Bilateral External $15,985 Iliac/Right, Left, Bilateral Femoral/Lower Extremity Artery/ Lower Artery with Synthetic RateD Bypass Splenic Artery to Right/Left/Bilateral Renal Artery with Synthetic Bypass Right Common Iliac Artery to Abdominal Aorta/Celiac/Mesenteric/ Right, Left, Bilateral Renal/Right, Left, Bilateral Common Iliac/ Right, Left, Bilateral Internal Iliac/Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/Lower Extremity Artery/ Lower Artery with Synthetic Bypass Left Common Iliac Artery to Abdominal Aorta/Celiac/Mesenteric/ Right, Left, Bilateral Renal/Right, Left, Bilateral Common Iliac/ Right, Left, Bilateral Internal Iliac/Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/Lower Extremity Artery/ Lower Artery with Synthetic Bypass Right Internal Iliac Artery to Right, Left, Bilateral Internal Iliac/ Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/ Foot Artery/Lower Extremity Artery with Synthetic Substitute, Bypass Left Internal Iliac Artery to Right, Left, Bilateral Internal Iliac/ Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/ Foot Artery/Lower Extremity Artery with Synthetic Substitute, Bypass Right External Iliac Artery to Right, Left, Bilateral Internal Iliac/ Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/ Foot Artery/Lower Extremity Artery with Synthetic Substitute, 04140J J5 041C0J0-041C0JR 041D0J0-041D0JR 041E0J9-041E0JQ 041F0J9-041F0JQ 041H0J9-041H0JQ
4 MS-DRG B Relative Weight C LOWER ARTERIES Bypass Left External Iliac Artery to Right, Left, Bilateral Internal Iliac/ 041J0J9-041J0JQ $30,904 Right, Left, Bilateral External Iliac/Right, Left, Bilateral Femoral/ $21,331 Foot Artery/Lower Extremity Artery with Synthetic Substitute, $15,985 Bypass Right Femoral Artery to Right, Left, Bilateral Femoral/Popliteal/ 041K0JH-041K0JQ $19,903 Peroneal/Posterior Tibial/Foot/Lower Extremity Artery with Synthetic $15, $11,051 RateD Bypass Left Femoral Artery to Right, Left, Bilateral Femoral/Popliteal/ Peroneal/Posterior Tibial/Foot/Lower Extremity Artery with Synthetic Bypass Right Femoral Artery to Lower Extremity Artery with Synthetic Bypass Left Femoral Artery to Lower Extremity Artery with Synthetic Bypass Right Popliteal Artery to Popliteal/Peroneal/Foot/Lower Extremity Artery with Synthetic Bypass Left Popliteal Artery to Popliteal/Peroneal/Foot/Lower Extremity Artery with Synthetic Bypass Right Popliteal Artery to Lower Extremity Artery with Synthetic Bypass Left Popliteal Artery to Lower Extremity Artery with Synthetic Bypass Right Anterior Tibial Artery to Lower Extremity Artery with Synthetic Substitute, Open/Percutaneous Approach 041L0JH-041L0JQ 041K3JQ 041L3JQ 041M0JL-041M0JQ 041N0JL-041N0JQ 041M3JQ 041N3JQ 041P0JQ-041P3JQ
5 MS-DRG B Relative Weight C Rate D LOWER ARTERIES Bypass Left Anterior Tibial Artery to Lower Extremity Artery with Synthetic 041Q0JQ-041Q3JQ $19,903 Substitute, Open/Percutaneous Approach $15, $11,051 Bypass Right Posterior Tibial Artery to Lower Extremity Artery with Synthetic 041R0JQ-041R3JQ Substitute, Open/Percutaneous Approach Bypass Left Posterior Tibial Artery to Lower Extremity Artery with Synthetic Substitute, Open/Percutaneous Approach Bypass Right Peroneal Artery to Foot/Lower Extremity Artery with Synthetic Bypass Left Peroneal Artery to Foot/Lower Extremity Artery with Synthetic Bypass Right Foot Artery to Foot/Lower Extremity Artery with Synthetic Bypass Left Foot Artery to Foot/Lower Extremity Artery with Synthetic Bypass Right, Left Peroneal/Right, Left Foot Artery to Lower Extremity Artery with Synthetic 041S0JQ-041S3JQ 041T0JP-041T0JQ 041U0JP-041U0JQ 041V0JP-041V0JQ 041W0JP-041W0JQ 041T3JQ-041W3JQ
6 MS-DRG Descriptions DRG 037 Extracranial procedures with MCC DRG 038 Extracranial procedures with CC DRG 039 Extracranial procedures without CC/MCC DRG 252 Other vascular procedures with MCC DRG 253 Other vascular procedures with CC DRG 254 Other vascular procedures without CC/MCC DRG 270 Other major cardiovascular procedures with MCC DRG 271 Other major cardiovascular procedures with CC DRG 272 Other major cardiovascular procedures without CC/MCC REV102218PT
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