Summary & Overview

Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 137 includes inpatient admissions for mouth procedures where patients have Complication or Comorbidity or Major Complication or Comorbidity that increase clinical complexity. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment with Complication or Comorbidity or Major Complication or Comorbidity status determines higher Medicare payment weights to reflect increased resource use.

Mouth Procedures with CC/MCCDRG Mouth Procedures with CC/MCCDRG 137Diagnosis-Related GroupInpatient ReimbursementMedicareOral SurgeryMaxillofacialHead and Neck Surgery

DRG 137 Overview

DRG 137 covers inpatient admissions for mouth procedures performed when a qualifying Complication or Comorbidity or Major Complication or Comorbidity is present, such as extensive oral surgery with significant comorbid conditions. It groups cases with higher resource use than uncomplicated mouth procedures and therefore yields higher Medicare payment relative to less complex mouth procedure groups. This classification affects reimbursement because the presence of Complication or Comorbidity or Major Complication or Comorbidity elevates the payment weight used in inpatient prospective payment. DRG 137 is used to align payment with expected hospital resource consumption for these more complex oral surgical admissions.

Summary & Overview

Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

Mouth Procedures with CC/MCCDRG Mouth Procedures with CC/MCCDRG 137Diagnosis-Related GroupInpatient ReimbursementMedicareOral SurgeryMaxillofacialHead and Neck Surgery

DRG 137 Overview

Clinical Trials

Acute perioperative infection prevention trials: randomized or pragmatic studies testing timing, dosing, or delivery methods of perioperative antibiotics, antiseptic mouthwashes, and intraoperative antisepsis protocols in adult and elderly patients undergoing complex oral and maxillofacial procedures with comorbidities (eg, diabetes, COPD, immunosuppression). These trials focus on immediate perioperative outcomes such as surgical site infection, reoperation, and length of stay, which directly affect inpatient resource use and reimbursement under this DRG. Evidence from these studies helps providers optimize protocols to reduce complications and helps payers anticipate costs and justify bundled-care or payment-policy decisions.
Comparative effectiveness studies of surgical techniques and care pathways: prospective cohort studies or randomized trials comparing different operative approaches (for example, tooth extraction with alveoloplasty versus conservative debridement, or open versus closed reduction when applicable), anesthesia strategies, or standardized enhanced recovery pathways in medically complex patients undergoing mouth procedures with complicating conditions (CC/MCC). These studies assess outcomes including postoperative complications, transfusion or ICU needs, readmissions, and functional recovery, informing which approaches yield better clinical results and lower total inpatient and post-acute costs. Payers and hospital case managers use this evidence to guide pathway implementation, utilization management, and DRG-based cost containment.
Post-discharge outcomes and care coordination research: observational studies and intervention trials evaluating discharge planning models, outpatient follow-up protocols, home nursing, and rehabilitation tailored to patients with significant comorbidities after complex oral procedures. Research measures 30- and 90-day readmission rates, emergency visits for bleeding or infection, patient-reported oral function and nutrition, and total cost of care, identifying which post-discharge strategies reduce readmissions and downstream spending. Results are critical for providers and payers aiming to lower readmission penalties, improve patient recovery, and align incentives under bundled payment or value-based arrangements for DRG 137 episodes.

Related Codes

138-MOUTH-PROCEDURES-WITHOUT-CC-MCC

Mouth Procedures without CC/MCC: Inpatient Reimbursement Overview

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

Major Head and Neck Procedures with CC: Inpatient Reimbursement Overview

152-OTITIS-MEDIA-AND-URI-WITH-MCC

Otitis Media and URI 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

139-SALIVARY-GLAND-PROCEDURES

Salivary Gland Procedures: Inpatient Reimbursement Overview

151-EPISTAXIS-WITHOUT-MCC

Epistaxis without MCC: Inpatient Reimbursement Overview

149-DYSEQUILIBRIUM

Dysequilibrium: Inpatient Reimbursement Overview

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

Major Head and Neck Procedures with MCC: Inpatient Reimbursement Overview

136-SINUS-AND-MASTOID-PROCEDURES-WITHOUT-CC-MCC

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

147-EAR-NOSE-MOUTH-AND-THROAT-MALIGNANCY-WITH-CC

Ear, Nose, Mouth and Throat Malignancy with CC: Inpatient Reimbursement Overview

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OpenPayer

Summary & Overview

Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 137 Overview

OpenPayer

Summary & Overview

Mouth Procedures with CC/MCC: Inpatient Reimbursement Overview

DRG 137 Overview

Clinical Trials

Related Codes

Clinical Trials

Related Codes