Tracheostomy for Face, Mouth and Neck DRG 013 Reimbursement

Tracheostomy/Laryngectomy without CC/MCC: Inpatient Reimbursement Overview

DRG 013 covers tracheostomy for face, mouth, and neck diagnoses or laryngectomy without Complication or Comorbidity or Major Complication or Comorbidity; it defines the clinical scope of inpatient admissions for airway and head and neck surgical care. Correct classification matters for inpatient reimbursement because it determines the bundled Medicare Severity Diagnosis-Related Group payment level assigned to the admission.

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DRG 013 Overview

DRG 013 covers hospital admissions for patients who undergo tracheostomy related to face, mouth, and neck diagnoses or who undergo laryngectomy when no Complication or Comorbidity or Major Complication or Comorbidity is present. This Diagnosis-Related Group captures the acute inpatient resource use associated with airway surgery and post-operative care for head and neck pathology. It matters for Medicare payment because it groups similar clinical cases to set prospective reimbursement levels based on typical hospital resource consumption. Hospitals and coders must accurately document the primary procedures and comorbid conditions to ensure correct assignment to this Diagnosis-Related Group.

Tracheostomy/Laryngectomy without CC/MCC: Inpatient Reimbursement Overview

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DRG 013 Overview

Clinical Trials

Trials evaluating airway management strategies and timing of tracheostomy in patients undergoing tracheostomy for face, mouth, and neck diagnoses or laryngectomy during the index hospitalization: these studies focus on acute intervention questions such as percutaneous versus open tracheostomy approaches, optimal timing for tracheostomy placement after head and neck surgery or prolonged ventilation, and perioperative protocols to reduce immediate complications (bleeding, pneumothorax, airway loss). The patient population includes adults admitted for head and neck cancers, extensive facial trauma, or airway obstruction who require surgical airway procedures; outcomes include procedure-related morbidity, ICU length of stay, and time to oral intake. This research is relevant to providers and payers because procedural choice and timing directly affect inpatient resource utilization, complication-associated costs, and short-term discharge disposition.
Comparative effectiveness studies of reconstructive and voice/airway rehabilitation approaches after laryngectomy or tracheostomy in the subacute inpatient-to-early post-discharge phase: these studies compare different surgical reconstruction techniques, timing and type of voice restoration (e.g., prosthetic voice rehabilitation vs. esophageal speech training) and multidisciplinary pathways for swallowing and pulmonary hygiene. The population includes patients recovering from laryngectomy or tracheostomy performed for oncologic resections or severe neck pathology, with measured outcomes such as functional speech and swallowing recovery, readmission rates for aspiration or pulmonary complications, and need for home health or skilled nursing. Findings inform clinicians and payers about which rehabilitation pathways improve functional outcomes and reduce post-discharge utilization and costs.
Longitudinal outcomes and health services research assessing long-term survival, quality of life, and resource utilization after tracheostomy or laryngectomy performed for face, mouth, and neck diagnoses: these observational cohort studies follow patients from hospital discharge through months to years to quantify rates of late complications (stoma complications, chronic tracheostomy dependence), subsequent hospitalizations, outpatient care needs, and patient-reported quality of life. The studied cohort includes cancer survivors, trauma patients, and others who required surgical airway procedures, with attention to predictors of durable decannulation, prosthesis maintenance, and durable discharge setting. This research helps payers and health systems plan post-acute care resources, forecast long-term costs, and develop care pathways that may reduce preventable readmissions and improve value of care.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Trials evaluating airway management strategies and timing of tracheostomy in patients undergoing tracheostomy for face, mouth, and neck diagnoses or laryngectomy during the index hospitalization: these studies focus on acute intervention questions such as percutaneous versus open tracheostomy approaches, optimal timing for tracheostomy placement after head and neck surgery or prolonged ventilation, and perioperative protocols to reduce immediate complications (bleeding, pneumothorax, airway loss). The patient population includes adults admitted for head and neck cancers, extensive facial trauma, or airway obstruction who require surgical airway procedures; outcomes include procedure-related morbidity, ICU length of stay, and time to oral intake. This research is relevant to providers and payers because procedural choice and timing directly affect inpatient resource utilization, complication-associated costs, and short-term discharge disposition.
Comparative effectiveness studies of reconstructive and voice/airway rehabilitation approaches after laryngectomy or tracheostomy in the subacute inpatient-to-early post-discharge phase: these studies compare different surgical reconstruction techniques, timing and type of voice restoration (e.g., prosthetic voice rehabilitation vs. esophageal speech training) and multidisciplinary pathways for swallowing and pulmonary hygiene. The population includes patients recovering from laryngectomy or tracheostomy performed for oncologic resections or severe neck pathology, with measured outcomes such as functional speech and swallowing recovery, readmission rates for aspiration or pulmonary complications, and need for home health or skilled nursing. Findings inform clinicians and payers about which rehabilitation pathways improve functional outcomes and reduce post-discharge utilization and costs.
Longitudinal outcomes and health services research assessing long-term survival, quality of life, and resource utilization after tracheostomy or laryngectomy performed for face, mouth, and neck diagnoses: these observational cohort studies follow patients from hospital discharge through months to years to quantify rates of late complications (stoma complications, chronic tracheostomy dependence), subsequent hospitalizations, outpatient care needs, and patient-reported quality of life. The studied cohort includes cancer survivors, trauma patients, and others who required surgical airway procedures, with attention to predictors of durable decannulation, prosthesis maintenance, and durable discharge setting. This research helps payers and health systems plan post-acute care resources, forecast long-term costs, and develop care pathways that may reduce preventable readmissions and improve value of care.

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Tracheostomy/Laryngectomy without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 013 policy alerts

DRG 013 Overview

OpenPayer

Tracheostomy/Laryngectomy without CC/MCC: Inpatient Reimbursement Overview

Sign up for drg 013 policy alerts

DRG 013 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References