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CC and MCC List For DRG Coding

e-Medtools is providing, as a public service, a free abbreviated list of DRG Modifiers that qualify as Major Complications and Comorbid Conditions (MCC) & Complications and Comorbid Conditions(CC) as defined by the Centers for Medicare & Medicaid (CMS). These MCCs and CCs are important to every healthcare provider because they help hospitals maximize reimbursement in accordance with the appropriate level of severity of illness for a given patient. Every healthcare provider deserves to be paid appropriately for services provided. Healthcare is a team effort, and every member of the healthcare team owes it to themselves, their colleagues and their patients to work together for mutual benefit. At a time when Medicare continues to decrease reimbursement to all healthcare providers, it is more important than ever to work diligently to educate ourselves on navigating an increasingly complex reimbursement system. Hospitals play a important role in every community. Hospitals routinely provide free access to healthcare without regard to ability to pay for services rendered. Hospitals are often major employers in communities, and are often integral to community support efforts. It is therefor critical to support hospitals by every possible means to ensure that they can receive payment appropriate for the level of care provided. One important note: MCCs and CCs use terminology specific to the CMS, and MUST be documented by a healthcare practitioner, preferentially in the Discharge Summary. Medicare regulations prohibit Hospitals from providing this information to healthcare providers. Please consider reviewing this form, print as many copies as you like, and check all that apply and include this information in your patient documentation.

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27K views

CC and MCC List For DRG Coding

e-Medtools is providing, as a public service, a free abbreviated list of DRG Modifiers that qualify as Major Complications and Comorbid Conditions (MCC) & Complications and Comorbid Conditions(CC) as defined by the Centers for Medicare & Medicaid (CMS). These MCCs and CCs are important to every healthcare provider because they help hospitals maximize reimbursement in accordance with the appropriate level of severity of illness for a given patient. Every healthcare provider deserves to be paid appropriately for services provided. Healthcare is a team effort, and every member of the healthcare team owes it to themselves, their colleagues and their patients to work together for mutual benefit. At a time when Medicare continues to decrease reimbursement to all healthcare providers, it is more important than ever to work diligently to educate ourselves on navigating an increasingly complex reimbursement system. Hospitals play a important role in every community. Hospitals routinely provide free access to healthcare without regard to ability to pay for services rendered. Hospitals are often major employers in communities, and are often integral to community support efforts. It is therefor critical to support hospitals by every possible means to ensure that they can receive payment appropriate for the level of care provided. One important note: MCCs and CCs use terminology specific to the CMS, and MUST be documented by a healthcare practitioner, preferentially in the Discharge Summary. Medicare regulations prohibit Hospitals from providing this information to healthcare providers. Please consider reviewing this form, print as many copies as you like, and check all that apply and include this information in your patient documentation.

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e-MedTools
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© Attribution Non-Commercial (BY-NC)
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Major Complications and Comorbid Conditions (MCC) & Complications and Comorbid Conditions (CC)

Abbreviated CMS List of MCCs and CCs

Major Complications/Comorbid Conditions Complications/Comorbid Conditions Complications/Comorbid Conditions

Cardiovascular/Cerebrovascular Cardiovascular & Vascular Gastrointestinal


❑Congestive Heart Failure, Acute ❑Myocardial Ischemia, Acute, Without MI ❑Ascites
Acute on Chronic ❑Angina, Unstable ❑Attention to Gastrostomy
Systolic or Diastolic ❑Complete Block ❑C. Difficile Enteritis
❑Cor Pulmonale, Acute AV or Mobitz Type II ❑Cholelithiasis with Cholecystitis
❑CVA, Stroke, Cerebral Infarct or Hemorrhage Trifascicular or BBB ❑Colitis, Enteritis or Gastroenteritis
❑Cerebral Edema ❑Atrial Flutter of Presumed Infectious Origin
❑Coma ❑CAD of Bypass Graft ❑Colitis, Ischemic or Ulcerative
❑Endocarditis or Myocarditis, Acute ❑Congestive Heart Failure ❑Colostomy or Enterostomy, Complications
❑MI, Acute Chronic or Unspecified ❑Crohn’s Disease
❑Pulmonary Embolism, Acute Systolic or Diastolic ❑Diverticulitis
❑Cardiomyopathy EXCEPT Ischemic ❑Esophagitis, Acute
Respiratory & Infectious Disease ❑Demand Ischemia ❑Gastroenteritis, Toxic or due to Radiation
❑Aspiration Bronchitis, Aspiration Pneumonia ❑Heart Failure, Left ❑GI Bleed, Melena, Hematemesis, Hemoptysis
❑HIV Disease ❑Hypertension, Accelerated or Malignant ❑Hernia with Obstruction
❑Peritonitis ❑Hypertensive Heart Disease with CHF ❑Ileus
❑Pneumonia, Including viral ❑Hypertensive Encephalopathy ❑Intestinal Infections, Viral or Bacterial
❑Pulmonary Edema, Acute, Non-cardiogenic ❑In-Stent Stenosis, Cardiac ❑Intestinal Malabsorption
❑Respiratory Failure, Acute ❑Pleural Effusion ❑Jaundice
❑Respiratory Insufficiency ❑Post-MI Syndrome ❑Pancreatitis, Chronic
Acute Post-Operative ❑Tachycardia, Sustained PSVT ❑Ulcer, Acute Gastric, Duodenal or Peptic
❑Sepsis, Severe Sepsis, Septic Shock ❑Thrombophlebitis & Venous Thrombosis
Acute or Chronic Nephrology & Genitourinary
Other MCCs ❑Acute Renal Failure
❑Acute Renal Failure with Behavioral, Nervous & Cerebrovascular ❑Calculus of Ureter or Kidney
Acute Tubular Necrosis (ATN) ❑Alzheimer’s Dementia with Behavioral ❑Chronic Kidney Disease, Stage IV or V
❑Aplastic, Anemia due to Disturbance ❑Hydronephrosis or Hydroureter
Drugs, Chemo, Infection, or ❑Aphasia, NOT Post-Stroke ❑Nephrotic Syndrome
Radiation ❑Delirium, Drug Induced ❑Polycystic Kidney
❑Diabetic Ketoacidosis or Diabetes with ❑Dementia with ❑Pyelonephritis, UTI
Hyperosmolarity or Other Coma Delirium, Depression or Delusion
❑Encephalopathy Presenile, Senile or Vascular Orthopedic & Skin
Metabolic or Toxic ❑Depression, Major, Acute ❑Cellulits, EXCEPT Fingers or Toes
Other or Unspecified ❑Encephalopathy, Alcoholic ❑Compartment Syndrome, Non-Traumatic
❑End Stage Renal Disease ❑Hallucinations ❑Complications of Prosthetic Joint
❑GI Disorder With Auditory OR Drug/Alcohol-Induced ❑Fractures, Pathologic
Hemorrhage, Gastritis, Duodenitis ❑Hemiplegia, Hemiparesis ❑Fractures, Traumatic, Closed/Many Sites
Or Diverticular Disease ❑Normal Pressure Hydrocephalus ❑Osteomyelitis, Acute, Chronic or Unspecified
❑GI Ulcer With Perforation, Hemorrhage or ❑Paraplegia ❑Stasis Ulcer, Inflamed or Infected
Obstruction ❑Post-Traumatic Seizures ❑Ulcer of Skin, Lower Extremity
❑Ischemic Colitis, Acute ❑Schizophrenia EXCEPT Unspecified
❑Major Injuries ❑Suicidal Ideation Respiratory
❑Malnutrition, Severe ❑TIA ❑Asthma Exacerbation
❑Pancreatitis, Acute ❑Vertebrobasilar Insufficiency ❑Atelectasis
❑Peritonitis ❑Withdrawal, Drug or Alcohol ❑COPD with Acute Exacerbation
❑Pressure Ulcer Stage III OR IV ❑Emphysema
❑Quadriplegia or Functional Quadriplegia Hematology & Oncology with Exacerbation of Chronic Bronchitis
❑SIRS due to Noninfectious Process with ❑Anemia due to Acute or Post-Op Blood Loss ❑Hemoptysis
Acute Organ Dysfunction ❑Aplastic Anemia ❑Pulmonary Edema, Non-Cardiogenic
❑Volvulus ❑Lymphoma, Leukemia Also In Remission ❑Respiratory Distress, Acute
❑Malignant Neoplasm, Most Sites ❑Respiratory Failure, Chronic
MCC IF Discharged Alive NOT Breast or Prostate ❑Respirator Weaning or Dependence
❑Cardiac Arrest ❑Pancytopenia
❑Cardiogenic Shock ❑Secondary Neuroendocrine Tumor Other
❑Respiratory Arrest ❑Bacteremia
❑Ventricular Fibrillation Metabolic ❑Complications of Device, Implant or Graft
❑Other Shock without Trauma ❑Acidosis/Alkalosis ❑SIRS due to Non-Infectious Process
❑Adult BMI <19 OR ≥40 ❑Thrush
❑Cachexia ❑Transplant Status, Most Organs
❑Hypernatremia OR Hyponatremia
❑Malnutrition, Unspecified
❑Obesity Hypoventilation Syndrome

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