Skip to main content
MS-DRG 216 · MDC 05 · Surgical

MS-DRG 216: Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: IPPS Table 5 FY2027 final rule (effective October 1, 2026); Definitions Manual v44 (effective October 1, 2026). Next CMS release: April 1, 2027 (v44.1 mid-year update), then the FY2028 final rule in August 2027.

Key facts for DRG 216

FY2027 relative weight
9.8820
Higher than 98% of all MS-DRGs
Change vs FY2026
+1.0%
FY2026 weight 9.7830
Geometric mean LOS
10.5 days
Arithmetic mean 13.4 days
MDC
05
Assignment of Diagnosis Codes
Severity level
with MCC (major complication or comorbidity)
Transfer policy
Post-acute transfer DRG
Special-pay DRG

TL;DR

MS-DRG 216 is a surgical group in MDC 05 (Assignment of Diagnosis Codes) at the highest-severity level of its family. CMS assigns it a FY2027 relative weight of 9.8820 with a geometric mean length of stay of 10.5 days and an arithmetic mean of 13.4. Its weight moved up 1.0% from FY2026 (9.7830). That weight is higher than 98% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 217, DRG 218) spans weights 6.8050 to 9.8820. The v44 Definitions Manual assigns it through 304 operating room procedures codes.

What changed from FY2026 to FY2027

CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 216 the FY2027 relative weight is 9.8820 against 9.7830 in FY2026, a rise of 1.01%.

FY2026 versus FY2027 payment factors for MS-DRG 216
MetricFY2026FY2027Change
Relative weight9.78309.8820+0.0990
Geometric mean LOS (days)10.610.5-0.1
Arithmetic mean LOS (days)13.613.4-0.2
Weights shown are the FY2027 final values after the 10% cap on year-over-year reductions where applicable.

CC and MCC family

DRG 216 shares its base definition with 2 other MS-DRGs split by severity. The family's weights span 6.8050 to 9.8820, a 1.45× spread, which is the payment effect of documenting qualifying complications and comorbidities.

MS-DRGs in the same base group as DRG 216
DRGTitleFY2027 weightGMLOS
216Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC9.882010.5
217Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC6.80503.9
218Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC6.80503.9

Grouper logic (v44 Definitions Manual)

Operating Room Procedures: 304 ICD-10 codes drive assignment to this group; the first 12 are shown.

Operating Room Procedures codes assigned to DRG 216 (sample)
ICD-10 codeDescription
024F07JCreation of Aortic Valve from Truncal Valve using Autologous Tissue Substitute, Open Approach
024F08JCreation of Aortic Valve from Truncal Valve using Zooplastic Tissue, Open Approach
024F0JJCreation of Aortic Valve from Truncal Valve using Synthetic Substitute, Open Approach
024F0KJCreation of Aortic Valve from Truncal Valve using Nonautologous Tissue Substitute, Open Approach
024G072Creation of Mitral Valve from Common Atrioventricular Valve using Autologous Tissue Substitute, Open Approach
024G082Creation of Mitral Valve from Common Atrioventricular Valve using Zooplastic Tissue, Open Approach
024G0J2Creation of Mitral Valve from Common Atrioventricular Valve using Synthetic Substitute, Open Approach
024G0K2Creation of Mitral Valve from Common Atrioventricular Valve using Nonautologous Tissue Substitute, Open Approach
024J072Creation of Tricuspid Valve from Common Atrioventricular Valve using Autologous Tissue Substitute, Open Approach
024J082Creation of Tricuspid Valve from Common Atrioventricular Valve using Zooplastic Tissue, Open Approach
024J0J2Creation of Tricuspid Valve from Common Atrioventricular Valve using Synthetic Substitute, Open Approach
024J0K2Creation of Tricuspid Valve from Common Atrioventricular Valve using Nonautologous Tissue Substitute, Open Approach

Documentation and denial exposure

As a surgical DRG, assignment depends on a qualifying operating-room procedure being coded from the operative report; a missing or non-OR procedure code drops the stay into a medical DRG in MDC 05 with a lower weight. Because this family splits by severity, auditors target CC and MCC capture: each secondary diagnosis must be documented as present, monitored, evaluated or treated during the stay to survive a DRG-validation review. Typical inpatient denial codes for this group: CARC 16 (claim lacks information needed to group the stay), CARC 50 (the admission or procedure is judged not medically necessary), CARC 97 (a service is bundled into the DRG payment).

How QuickIntell uses DRG 216 data

QuickCode groups inpatient encounters against the current v44 logic, flags CC and MCC candidates that lack supporting documentation, and shows the weight difference across the family before the claim drops. QuickScribe captures the attending's language that supports severity, and QuickRCM works DRG-validation denials with the grouper evidence attached.

Explore QuickCodeExplore QuickScribeBook a demo

Frequently asked questions — DRG 216

What is MS-DRG 216?

MS-DRG 216 is "Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC", a surgical Medicare Severity Diagnosis-Related Group in MDC 05, Assignment of Diagnosis Codes. Medicare pays inpatient stays grouped here at the hospital's base rate multiplied by the DRG relative weight.

What is the FY2027 relative weight for DRG 216?

The FY2027 relative weight is 9.8820 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 9.7830, a change of +1.0%.

What is the average length of stay for DRG 216?

CMS reports a geometric mean length of stay of 10.5 days and an arithmetic mean of 13.4 days for FY2027. The geometric mean is used for transfer-payment calculations.

Which DRGs are in the same CC/MCC family as 216?

DRG 217 (Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC, weight 6.8050); DRG 218 (Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC, weight 6.8050). The family's weights range from 6.8050 to 9.8820, so documented complications and comorbidities change payment materially.

What documentation supports the severity level of DRG 216?

DRG 216 requires at least one secondary diagnosis on the CMS Major Complication or Comorbidity list, documented as present and clinically addressed during the stay (monitored, evaluated, treated or extending the stay). Conditions such as acute respiratory failure, severe sepsis or acute kidney injury with specified cause qualify only when the attending's note states the diagnosis itself, not just the lab values. Recovery auditors downgrade this group to the CC or base level when the MCC rests on an unconfirmed query or a resolved historical condition, so the query response and the discharge summary must agree.

Which codes group to DRG 216?

The v44 Definitions Manual lists 304 operating room procedures codes for this group. Examples from the operating room procedures list: 024F07J (Creation of Aortic Valve from Truncal Valve using Autologous Tissue Substitute, Open Approach); 024F08J (Creation of Aortic Valve from Truncal Valve using Zooplastic Tissue, Open Approach); 024F0JJ (Creation of Aortic Valve from Truncal Valve using Synthetic Substitute, Open Approach); 024F0KJ (Creation of Aortic Valve from Truncal Valve using Nonautologous Tissue Substitute, Open Approach).

Is DRG 216 a post-acute transfer DRG?

Yes. CMS flags DRG 216 under the post-acute care transfer policy, so a discharge to a qualifying post-acute setting before the geometric mean length of stay is paid a per-diem amount rather than the full DRG payment. It is also a special-pay DRG.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from the CMS IPPS FY2027 final rule (Table 5) and the v44 ICD-10 MS-DRG Definitions Manual. Relative weights are national factors; actual payment depends on each hospital's wage-adjusted base rate, add-ons, outliers and transfer adjustments. Nothing here is legal, clinical or billing advice; verify grouping against your encoder and the published CMS files.