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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Ear, Nose, Mouth and ThroatDRG 136-sinus-and-mastoid-procedures-without-cc-mcc
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    Sinus and Mastoid Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 136 encompasses inpatient admissions for sinus and mastoid procedures without a Major Complication or Comorbidity and without a Complication or Comorbidity and defines the clinical scope of cases eligible for a standard payment weight. It matters for inpatient reimbursement because it standardizes payment for these procedures under the prospective payment system and is sensitive to coding of procedures and secondary diagnoses that could change the Diagnosis-Related Group and payment.

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    DRG 136 Overview

    DRG 136 covers inpatient admissions for sinus and mastoid procedures without a Major Complication or Comorbidity and without a Complication or Comorbidity. It includes operative management of chronic or acute sinus and mastoid disease when the admission does not carry higher-severity secondary diagnoses. This Diagnosis-Related Group matters for Medicare payment because it groups similar resource use and determines the prospective payment amount for hospitals under the inpatient prospective payment system. Accurate coding and documentation of procedures and secondary diagnoses affect assignment to this Diagnosis-Related Group and the resulting Medicare reimbursement.

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    Clinical Trials

    • Trials evaluating minimally invasive surgical techniques versus traditional open sinus or mastoid procedures: these studies compare operative approaches (endoscopic sinus surgery, balloon sinuplasty, or transmastoid endoscopic techniques) in patients with chronic rhinosinusitis or chronic otitis media requiring operative intervention without major comorbidity. They enroll mostly otherwise healthy adults and focus on intraoperative metrics, short-term complication rates, operative time, and early symptom relief to determine whether less invasive approaches reduce length of stay and perioperative resource use. Results are directly relevant to hospitals and payers because reductions in complications, operative time, and LOS can lower episode costs and influence DRG resource utilization.
    • Comparative effectiveness trials of perioperative antibiotic and steroid protocols to reduce recurrence and readmission: these randomized or pragmatic studies examine different antibiotic stewardship strategies, topical or systemic steroid regimens, or combinations thereof in patients undergoing sinus or mastoid surgery who do not have major CC/MCC. The objective is to measure postoperative infection rates, need for revision procedures, and unplanned clinic or ED visits within 30–90 days, identifying protocols that optimize outcomes while minimizing unnecessary antimicrobial use. Findings inform clinical pathways, discharge instructions, and payer policies by highlighting strategies that decrease readmissions and downstream costs associated with postoperative complications.
    • Longitudinal outcomes and quality-of-life studies after index sinus or mastoid procedures focused on return-to-function and resource utilization: these observational cohort studies follow patients after discharge to measure symptom control, hearing outcomes (for mastoid surgery), sinonasal quality-of-life scores, use of outpatient services, and rates of revision surgery over 1–2 years. They typically include PROMs and healthcare utilization endpoints to capture durable effectiveness of the index hospitalization and identify predictors of high-cost post-acute care (e.g., comorbid allergic disease or smoking). This research helps providers and payers understand long-term value of the initial procedure, guide case selection for inpatient surgery under this DRG, and design follow-up care pathways that reduce preventable downstream spending.

    Related Codes

    135-SINUS-AND-MASTOID-PROCEDURES-WITH-CC-MCC

    Sinus and Mastoid Procedures with 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

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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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