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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Nervous SystemDRG 086-traumatic-stupor-and-coma-1-hour-with-cc
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    Traumatic Stupor and Coma <1 Hour with CC: Inpatient Reimbursement Overview

    DRG 086 applies to inpatient stays for traumatic stupor and coma lasting under one hour with a Complication or Comorbidity, defining a specific clinical and billing cohort for acute traumatic neurologic injury. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment and the presence of a Complication or Comorbidity determine resource-based payment under Medicare.

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    DRG 086 Overview

    DRG 086 covers inpatient cases coded for traumatic stupor and coma lasting less than one hour with a documented Complication or Comorbidity. It captures patients with acute, transient severe neurologic impairment resulting from trauma who require inpatient care for monitoring, imaging, and potential interventions. This Diagnosis-Related Group influences Medicare payment by grouping resource intensity for short-duration traumatic altered consciousness with added complexity from comorbid conditions. Accurate clinical capture and coding of the Complication or Comorbidity affect reimbursement and case mix assignment.

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    Clinical Trials

    • Acute emergency intervention trials assessing airway management strategies, intracranial pressure monitoring protocols, or early neurosurgical decision algorithms for patients presenting with traumatic stupor or coma lasting less than one hour with complicating conditions (CC). These studies enroll adult and older adolescent trauma patients in the hyperacute phase (prehospital and first 24 hours) to compare procedural timing, method (for example different airway devices or timing of decompression), and monitoring approaches; outcomes include survival, neurologic recovery at discharge, and complication rates. Results inform emergency care pathways and resource allocation decisions for hospitals and payers by identifying interventions that improve short-term outcomes and reduce costly downstream complications.
    • Comparative effectiveness studies of in-hospital management strategies for patients with brief traumatic coma and CC, such as variants of ICU admission criteria, imaging surveillance frequency, or use of targeted rehabilitation consultation during the index admission. These prospective or pragmatic randomized studies target heterogeneous inpatient populations with coexisting conditions (anticoagulation, multi-system injuries, or medical comorbidities) to determine which care bundles reduce length of stay, readmissions, and inpatient complications. Payers and providers benefit because evidence can guide appropriate level-of-care placement and utilization management to balance patient safety with cost containment.
    • Post-discharge longitudinal outcomes and health services research examining functional recovery, cognitive outcomes, return to work, and long-term healthcare utilization for survivors of brief traumatic coma with CC. Cohort studies and registry-based analyses follow patients from discharge through months to years, assessing rehabilitation utilization, neuropsychological sequelae, and predictors of costly readmissions or institutional care. This research is relevant for designing post-acute care pathways, risk-adjusted reimbursement models, and targeted interventions to improve long-term outcomes and reduce total cost of care for this DRG population.

    Related Codes

    020-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with MCC: Inpatient Reimbursement Overview

    021-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITH-CC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage with CC: Inpatient Reimbursement Overview

    022-INTRACRANIAL-VASCULAR-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-HEMORRHAGE-WITHOUT-CC-MCC

    Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage without CC/MCC: Inpatient Reimbursement Overview

    023-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITH-MCC-OR-ANTINEOPLASTIC-IMPLANT-OR-EPILEPSY-WITH-NEUROSTIMULATOR

    Craniotomy with Major Device Implant or Complex CNS DRG 023: Inpatient Reimbursement Overview

    024-CRANIOTOMY-WITH-MAJOR-DEVICE-IMPLANT-OR-ACUTE-COMPLEX-CNS-PRINCIPAL-DIAGNOSIS-WITHOUT-MCC

    Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis without MCC: Inpatient Reimbursement Overview

    025-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-MCC

    Craniotomy and Endovascular Intracranial Procedures with MCC: Inpatient Reimbursement Overview

    026-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITH-CC

    Craniotomy and Endovascular Intracranial Procedures with CC: Inpatient Reimbursement Overview

    027-CRANIOTOMY-AND-ENDOVASCULAR-INTRACRANIAL-PROCEDURES-WITHOUT-CC-MCC

    Craniotomy and Endovascular Intracranial Procedures without CC/MCC: Inpatient Reimbursement Overview

    028-SPINAL-PROCEDURES-WITH-MCC

    Spinal Procedures with MCC: Inpatient Reimbursement Overview

    029-SPINAL-PROCEDURES-WITH-CC-OR-SPINAL-NEUROSTIMULATORS

    Spinal Procedures with CC or Spinal Neurostimulators: Inpatient Reimbursement Overview

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    References

    1. 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. 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. 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.
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