Summary & Overview

Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 135 covers sinus and mastoid surgical procedures when a Complication or Comorbidity or Major Complication or Comorbidity is present, defining clinical scope and case complexity. This Diagnosis-Related Group matters for inpatient reimbursement because the Complication or Comorbidity or Major Complication or Comorbidity designation affects payment by reflecting higher anticipated resource use.

Sinus and Mastoid Procedures with CC/MCCDRG Sinus and Mastoid Procedures with CC/MCCDRG 135Diagnosis-Related GroupInpatient ReimbursementMedicareOtolaryngologyOtologySinus surgeryMastoid surgery

DRG 135 Overview

DRG 135 covers inpatient admissions for patients undergoing sinus and mastoid procedures when a Complication or Comorbidity or Major Complication or Comorbidity is present. These procedures include surgical management of chronic or acute disease processes of the paranasal sinuses and the mastoid portion of the temporal bone, often involving otolaryngology or otology teams. This Diagnosis-Related Group matters for Medicare payment because the presence of a Complication or Comorbidity or Major Complication or Comorbidity increases reimbursement relative to uncomplicated cases, reflecting higher expected resource use. Accurate clinical documentation and coding of the secondary diagnoses that qualify as Complication or Comorbidity or Major Complication or Comorbidity are therefore central to appropriate inpatient payment.

Summary & Overview

Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

Sinus and Mastoid Procedures with CC/MCCDRG Sinus and Mastoid Procedures with CC/MCCDRG 135Diagnosis-Related GroupInpatient ReimbursementMedicareOtolaryngologyOtologySinus surgeryMastoid surgery

DRG 135 Overview

Clinical Trials

Acute surgical technique and perioperative complication reduction trials: randomized or quasi-experimental studies that compare different operative approaches (for example endoscopic sinus surgery variations, mastoidectomy techniques, or adjunctive intraoperative measures) and perioperative protocols aimed at reducing bleeding, cerebrospinal fluid leak, facial nerve injury, or postoperative infection. These studies typically enroll hospitalized adults or children undergoing sinus or mastoid procedures with documented complications or comorbid conditions (the CC/MCC population), and measure short-term clinical endpoints such as intraoperative metrics, immediate complication rates, length of stay, and need for reoperation. Results inform surgeons and hospital administrators about techniques and processes that can lower acute morbidity and resource use in this high-acuity DRG.
Comparative effectiveness studies of perioperative medical management and antimicrobial strategies: prospective cohort studies or pragmatic randomized trials evaluating variations in preoperative optimization (such as management of anticoagulation, corticosteroid use, or diabetic control), intra- and postoperative antibiotic regimens, and topical therapies to prevent surgical site infection and persistent disease. These trials focus on patients with significant comorbidities or more extensive disease who fall into the CC/MCC grouping and assess outcomes including readmission, infection, antibiotic exposure, and total inpatient cost. Findings are directly relevant to payers and care managers because they identify medical-management approaches that may reduce complications, shorten stays, and decrease overall inpatient expenditures for this DRG.
Post-discharge functional outcomes and health-utilization studies: prospective observational or registry-based research tracking quality of life, symptom control (breath/sinus symptoms, hearing), need for revision surgery, outpatient rehabilitative services, and unplanned healthcare utilization over months to years after index sinus or mastoid procedures. These studies enroll the DRG population at discharge and stratify by presence of CC/MCCs, procedural complexity, and social determinants of health to determine predictors of long-term resource use and patient-reported outcomes. Results help providers and payers target post-acute care coordination, outpatient follow-up intensity, and bundled-payment or case-management strategies to reduce readmissions and improve value for patients within this diagnosis-related group.

Sinus and Mastoid Procedures without CC/MCC: Inpatient Reimbursement Overview

137-MOUTH-PROCEDURES-WITH-CC-MCC

Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

138-MOUTH-PROCEDURES-WITHOUT-CC-MCC

Mouth Procedures without CC/MCC: Inpatient Reimbursement Overview

139-SALIVARY-GLAND-PROCEDURES

Salivary Gland Procedures: Inpatient Reimbursement Overview

140-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-MCC

Major Head and Neck Procedures with MCC: Inpatient Reimbursement Overview

141-MAJOR-HEAD-AND-NECK-PROCEDURES-WITH-CC

Major Head and Neck Procedures with CC: Inpatient Reimbursement Overview

142-MAJOR-HEAD-AND-NECK-PROCEDURES-WITHOUT-CC-MCC

Major Head and Neck Procedures without CC/MCC: Inpatient Reimbursement Overview

143-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-MCC

Other Ear, Nose, Mouth and Throat O.R. Procedures with MCC: Inpatient Reimbursement Overview

144-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITH-CC

Other Ear, Nose, Mouth and Throat O.R. Procedures with CC: Inpatient Reimbursement Overview

145-OTHER-EAR-NOSE-MOUTH-AND-THROAT-O-R-PROCEDURES-WITHOUT-CC-MCC

Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

Showing 1–10 of 24

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

OpenPayer

Summary & Overview

Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 135 Overview

OpenPayer

Summary & Overview

Sinus and Mastoid Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 135 Overview

Clinical Trials

Related Codes

Clinical Trials

Related Codes