Inpatient CC/MCC Bundles

The following outlines the various types of inpatient bundles and what is and is not included within them.

Inpatient claims are coded by a facility utilizing an MS-DRG, a unique three-digit code that is assigned to each claim based on the diagnosis, surgical procedures, patient age, and other factors.

MS-DRG codes can range based on the presence of complications or comorbidities. Complications and Comorbidities can affect the treatment plan, length of hospital stay, or overall healthcare costs. See below the difference between Complications and Comorbidities (CC) and Major Complications and Comorbidities (MCC).

Complications and Comorbidities (CC)

Complications and Comorbidities are additional conditions or diseases that develop during a patient’s hospital stay or are present at the time of admission. Examples are pneumonia upon arrival, surgical site infection, history of smoking for increased risk of blood clot, etc.

Major Complications and Comorbidities (MCC)

These are more severe conditions than CCs. Major complications and comorbidities can have a substantial impact on the patient’s care. Examples are End-Stage Renal Disease (ESRD), sepsis, respiratory failure, diabetes with complications, etc.

Below is an example of MS-DRGs with codes for non-complicated, CC, and MCC assignments.

DRG 621 – O.R. Procedures for Obesity without CC/MCC

DRG 620 – O.R. Procedures for Obesity with CC

DRG 619 – O.R. Procedures for Obesity with MCC

An example of a procedure that has been built with the three levels of DRG codes looks something like this:

You will notice that the physician, anesthesia, and pathology price all remain the same for each of the different levels because the procedure being performed is the same procedure in the non-complicated procedure (Gastric Bypass Roux-En-Y). The facility increase in cost will make up for the extra care that is needed to take care of a patient with complications and/or comorbidities.

Inpatient Hospital Days

We utilize the Medicare average length of stay for our inpatient bundles. For example, if the average length of stay is 3.2 days, our site would read:

Facility fee - Operating and recovery room services & supplies for a normal inpatient stay (average 3 to 4 days) which will be determined by your physician at {hospital_name}.

DRG Rates

We utilize the Medicare national DRG rate

Disclaimers

Since a patient may be required to purchase a higher priced procedure due to their complications or comorbidities, the View Details section on all MPPX pages notes that for inpatient procedures, a higher priced procedure may need to be purchased based on complications or pre-existing conditions.