Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 116 groups inpatient admissions for intraocular surgical procedures with a Complication or Comorbidity or Major Complication or Comorbidity, covering more complex or complicated eye operations. It matters for inpatient reimbursement because the Complication or Comorbidity and Major Complication or Comorbidity designations increase the Medicare Severity Diagnosis-Related Group payment weight and therefore hospital payment under Centers for Medicare & Medicaid Services rules.

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DRG 116 Overview

DRG 116 covers inpatient hospital admissions for intraocular surgical procedures performed for a range of eye conditions when there is a documented Complication or Comorbidity or Major Complication or Comorbidity. These cases typically include complex cataract extractions, intraocular lens procedures, and other microsurgical interventions complicated by additional diagnoses that increase resource use. This Diagnosis-Related Group matters for Medicare payment because the presence of Complication or Comorbidity or Major Complication or Comorbidity elevates the relative payment weight and affects hospital reimbursement. Accurate coding of the principal procedure and coexisting diagnoses directly influences payment under Centers for Medicare & Medicaid Services inpatient prospective payment policies.

Clinical Trials

Acute intraoperative device and technique trials: randomized or prospective studies comparing alternative intraocular surgical techniques (for example, variations in vitrectomy gauge, lens implantation approaches, or intraocular tamponade agents) in patients undergoing inpatient intraocular procedures with significant comorbidity. These trials typically enroll patients with complex pathology (traumatic globe injuries, dense cataracts with ocular comorbidities, advanced diabetic retinopathy, or emergency retinal detachments) to assess short-term surgical success, complication rates, and need for reoperation. Results inform surgeons and hospital administrators about procedural efficacy, intraoperative safety, and resource utilization during the index admission, which directly affects DRG-related inpatient LOS and complication-related cost drivers.
Comparative effectiveness and perioperative management studies: observational cohort studies or randomized trials evaluating different perioperative care pathways (for example, antibiotic prophylaxis regimens, anticoagulation management strategies, or anesthesia approaches) in medically complex patients receiving intraocular procedures with CC/MCC. These studies focus on patients who have significant medical comorbidities (cardiovascular disease, diabetes with end-organ damage, or chronic anticoagulation) that raise the risk of perioperative complications, aiming to reduce postoperative infections, hemorrhage, or systemic events. Findings are relevant to payers and providers because optimized perioperative protocols can lower complication frequencies, readmissions, and total inpatient costs associated with DRG 116 episodes.
Post-discharge outcomes and functional recovery research: longitudinal studies and registry-based outcomes research tracking visual function, quality of life, and readmission or reoperation rates after inpatient intraocular procedures in high-risk populations (elderly patients, those with multiple chronic conditions, or those who required emergency inpatient surgery). These studies examine medium- to long-term outcomes such as visual acuity recovery, late complications (endophthalmitis, recurrent detachment), and healthcare utilization after discharge to identify predictors of poor recovery and targets for transitional care. Results help payers and hospital systems design post-acute care pathways, discharge planning, and follow-up schedules that may reduce readmissions and downstream costs tied to DRG 116 admissions.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

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.

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Clinical Trials

Acute intraoperative device and technique trials: randomized or prospective studies comparing alternative intraocular surgical techniques (for example, variations in vitrectomy gauge, lens implantation approaches, or intraocular tamponade agents) in patients undergoing inpatient intraocular procedures with significant comorbidity. These trials typically enroll patients with complex pathology (traumatic globe injuries, dense cataracts with ocular comorbidities, advanced diabetic retinopathy, or emergency retinal detachments) to assess short-term surgical success, complication rates, and need for reoperation. Results inform surgeons and hospital administrators about procedural efficacy, intraoperative safety, and resource utilization during the index admission, which directly affects DRG-related inpatient LOS and complication-related cost drivers.
Comparative effectiveness and perioperative management studies: observational cohort studies or randomized trials evaluating different perioperative care pathways (for example, antibiotic prophylaxis regimens, anticoagulation management strategies, or anesthesia approaches) in medically complex patients receiving intraocular procedures with CC/MCC. These studies focus on patients who have significant medical comorbidities (cardiovascular disease, diabetes with end-organ damage, or chronic anticoagulation) that raise the risk of perioperative complications, aiming to reduce postoperative infections, hemorrhage, or systemic events. Findings are relevant to payers and providers because optimized perioperative protocols can lower complication frequencies, readmissions, and total inpatient costs associated with DRG 116 episodes.
Post-discharge outcomes and functional recovery research: longitudinal studies and registry-based outcomes research tracking visual function, quality of life, and readmission or reoperation rates after inpatient intraocular procedures in high-risk populations (elderly patients, those with multiple chronic conditions, or those who required emergency inpatient surgery). These studies examine medium- to long-term outcomes such as visual acuity recovery, late complications (endophthalmitis, recurrent detachment), and healthcare utilization after discharge to identify predictors of poor recovery and targets for transitional care. Results help payers and hospital systems design post-acute care pathways, discharge planning, and follow-up schedules that may reduce readmissions and downstream costs tied to DRG 116 admissions.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

115-EXTRAOCULAR-PROCEDURES-EXCEPT-ORBIT

Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.