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Fiscal Year 2012 DRG Weights and Rates
for DRG Numbers Between 400 and 499
Notes:
  • * = low volume DRG with fewer than 10 cases. The Medicare weights and LOS are used for these DRGs.
  • # = PM-DRGs with fewer than 10 cases. An average weight over the past 5 years were used for these DRGs.
  • w cc = with Complications and Comorbidities.
  • w/o cc = without Complications or Comorbidities
  • CHAMPUS Weight and Threshold Summary for FY 2012
    DRG Number Description CHAMPUS Weight Arithmetic Mean
    Length
    of Stay
    Geometric Mean
    Length
    of Stay
    Short Stay
    Threshold
    405 PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.2204   15.6 10.8 2
    406 PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.6777   7.2 5.6 1
    407 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.8255   4.5 3.8 1
    408 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC 4.7293   13.4 11.3 3
    409 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC 2.7906   8.6 7.4 2
    410 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC 1.6070   5.0 4.3 1
    411 CHOLECYSTECTOMY W C.D.E. W MCC 3.0776   8.2 7.1 2
    412 CHOLECYSTECTOMY W C.D.E. W CC 2.0561   5.2 4.0 1
    413 CHOLECYSTECTOMY W C.D.E. W/O CC/MCC 1.0898   3.0 2.5 1
    414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC 4.5550   11.9 9.0 2
    415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC 1.8995   5.9 5.2 2
    416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC 1.4118   3.6 3.1 1
    417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 2.0561   5.2 4.2 1
    418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 1.6116   3.7 3.1 1
    419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 1.2407   2.4 2.0 1
    420 HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC 16.4016   33.1 8.2 1
    421 HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC 3.2263   9.9 4.9 1
    422 HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC 1.3680 * 3.7 2.9 2
    423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC 6.2218   15.2 10.7 1
    424 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC 2.5383   9.5 5.7 1
    425 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC 1.8897 * 5.0 3.7 2
    432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 2.1079   6.9 5.0 1
    433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 0.9642   4.2 3.3 1
    434 CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC 0.6121   3.8 3.3 1
    435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC 1.8940   6.9 5.2 1
    436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC 1.3604   5.3 4.0 1
    437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC 0.9689   3.0 2.4 1
    438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 2.2665   8.3 5.9 1
    439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 1.0574   4.8 3.8 1
    440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 0.7190   3.3 2.8 1
    441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC 2.2052   7.7 5.3 1
    442 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 1.0564   4.4 3.2 1
    443 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC 0.6777   3.1 2.5 1
    444 DISORDERS OF THE BILIARY TRACT W MCC 1.6240   5.4 4.1 1
    445 DISORDERS OF THE BILIARY TRACT W CC 0.9698   3.5 2.8 1
    446 DISORDERS OF THE BILIARY TRACT W/O CC/MCC 0.7281   2.3 1.9 1
    453 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC 11.7668   12.0 8.5 1
    454 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 7.3366   4.9 4.3 1
    455 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC 5.5906   3.1 2.6 1
    456 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W MCC 8.8908   10.0 8.3 2
    457 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W CC 7.0567   6.0 5.4 2
    458 SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR 9+ FUS W/O CC/MCC 5.1879   4.4 4.0 1
    459 SPINAL FUSION EXCEPT CERVICAL W MCC 6.2479   8.1 6.6 1
    460 SPINAL FUSION EXCEPT CERVICAL W/O MCC 4.0243   3.0 2.6 1
    461 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC 5.9923 * 8.6 6.7 2
    462 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC 3.4111   4.0 3.7 1
    463 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC 6.0409   16.0 11.9 2
    464 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC 3.0452   7.8 5.8 1
    465 WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC 1.9407   4.8 3.5 1
    466 REVISION OF HIP OR KNEE REPLACEMENT W MCC 4.3593   6.7 5.6 1
    467 REVISION OF HIP OR KNEE REPLACEMENT W CC 3.2237   3.9 3.5 1
    468 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC 2.6151   3.1 2.9 1
    469 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC 3.4337   6.5 5.4 1
    470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 2.1160   3.0 2.8 1
    471 CERVICAL SPINAL FUSION W MCC 3.9709   5.9 4.3 1
    472 CERVICAL SPINAL FUSION W CC 2.6593   2.1 1.7 1
    473 CERVICAL SPINAL FUSION W/O CC/MCC 2.1239   1.3 1.2 1
    474 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC 4.0058 * 11.8 8.9 2
    475 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC 1.4533   6.1 4.8 1
    476 AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC 1.0544   3.7 2.9 1
    477 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC 2.7658   10.3 7.5 1
    478 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC 2.5072   6.5 4.6 1
    479 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC 1.8635   3.5 2.4 1
    480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W MCC 3.4088   8.2 6.6 1
    481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC 2.1362   5.1 4.5 1
    482 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC/MCC 1.6633   3.0 2.5 1
    483 MAJOR JOINT & LIMB REATTACHMENT PROC OF UPPER EXTREMITY W CC/MCC 2.2904   2.4 2.1 1
    484 MAJOR JOINT & LIMB REATTACHMENT PROC OF UPPER EXTREMITY W/O CC/MCC 1.9672   1.9 1.7 1
    485 KNEE PROCEDURES W PDX OF INFECTION W MCC 3.4882 * 10.7 8.7 3
    486 KNEE PROCEDURES W PDX OF INFECTION W CC 2.0990   8.6 6.3 1
    487 KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC 1.3656   4.0 3.5 1
    488 KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC 1.7205   3.8 3.0 1
    489 KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC 1.4210   2.3 1.9 1
    490 BACK & NECK PROC EXC SPINAL FUSION W CC/MCC OR DISC DEVICE/NEUROSTIM 2.1308   2.9 2.1 1
    491 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 1.2507   1.6 1.3 1
    492 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W MCC 3.9465   9.4 6.8 1
    493 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC 2.2452   4.6 3.6 1
    494 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC/MCC 1.4279   2.5 2.1 1
    495 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC 4.1698   10.4 5.3 1
    496 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC 1.5930   4.2 3.2 1
    497 LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC 1.1118   2.1 1.6 1
    498 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC 1.5932   6.0 3.5 1
    499 LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC 0.9784   2.1 1.6 1