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    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Respiratory SystemDRG 178-respiratory-infections-and-inflammations-with-cc
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    Respiratory Infections and Inflammations with CC: Inpatient Reimbursement Overview

    DRG 178 encompasses inpatient admissions for respiratory infections and inflammations that have at least one Complication or Comorbidity, such as pneumonia with an underlying comorbid condition. This grouping matters for inpatient reimbursement because the Complication or Comorbidity status alters the Diagnosis-Related Group assignment and influences Medicare payment under the inpatient prospective payment methodology.

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    DRG 178 Overview

    DRG 178 covers hospital admissions for respiratory infections and inflammations where at least one Complication or Comorbidity is present, including conditions such as pneumonia, acute bronchitis, and other lower respiratory tract infections complicated by comorbid illness. This Diagnosis-Related Group groups patients by clinical similarity and resource intensity to determine Medicare payment for the inpatient stay. The presence of a Complication or Comorbidity increases expected resource use compared with cases without Complication or Comorbidity, which affects relative payment under Medicare inpatient prospective payment systems. Understanding this grouping is important for accurate coding and reimbursement classification.

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    Clinical Trials

    • Acute adjunctive therapy trials studying therapies given during the initial hospital stay to reduce respiratory failure and need for mechanical ventilation. These studies enroll adults admitted with community-acquired or acute exacerbations of chronic respiratory infections/inflammations (eg, severe bacterial pneumonia, acute exacerbation of chronic bronchitis with infection) and compare adjunctive anti-inflammatory or mucolytic approaches added to standard antibiotics and supportive care. Results inform in-hospital clinical pathways and resource use (ICU days, ventilator days), which directly affect DRG costs and payer reimbursement decisions.
    • Comparative effectiveness studies of antibiotic stewardship and diagnostic strategies to shorten length of stay and prevent readmission. These pragmatic trials or cohort studies evaluate different empiric antibiotic durations, rapid pathogen diagnostics, or biomarker-guided de-escalation in adults hospitalized with respiratory infections and comorbidities (eg, COPD, heart failure) to determine impacts on clinical outcomes, antibiotic exposure, and institutional length of stay. Findings are relevant to hospitals and payers because optimized diagnostic and prescribing strategies can lower costly inpatient days, antimicrobial resistance-related complications, and post-discharge utilization.
    • Post-discharge outcomes and care-transition trials assessing interventions to reduce 30-day readmissions and long-term morbidity after hospitalization for respiratory infections and inflammations. These trials enroll patients at discharge following an index admission described by this DRG and test bundled discharge interventions (eg, tailored home oxygen assessment, early outpatient follow-up, telemonitoring, pulmonary rehabilitation referrals) with outcomes including readmission rates, functional status, and downstream utilization. Such research matters to providers and payers by identifying scalable post-discharge programs that improve recovery, reduce repeat hospitalizations, and shift costs out of the inpatient setting.

    Related Codes

    163-MAJOR-CHEST-PROCEDURES-WITH-MCC

    Major Chest Procedures with MCC: Inpatient Reimbursement Overview

    164-MAJOR-CHEST-PROCEDURES-WITH-CC

    Major Chest Procedures with CC: Inpatient Reimbursement Overview

    165-MAJOR-CHEST-PROCEDURES-WITHOUT-CC-MCC

    Major Chest Procedures without CC/MCC: Inpatient Reimbursement Overview

    166-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITH-MCC

    Other Respiratory System O.R. Procedures with MCC: Inpatient Reimbursement Overview

    167-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITH-CC

    Other Respiratory System O.R. Procedures with CC: Inpatient Reimbursement Overview

    168-OTHER-RESPIRATORY-SYSTEM-O-R-PROCEDURES-WITHOUT-CC-MCC

    Other Respiratory System O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    173-ULTRASOUND-ACCELERATED-AND-OTHER-THROMBOLYSIS-WITH-PRINCIPAL-DIAGNOSIS-PULMONARY-EMBOLISM

    Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism: Inpatient Reimbursement Overview

    175-PULMONARY-EMBOLISM-WITH-MCC-OR-ACUTE-COR-PULMONALE

    Pulmonary Embolism with MCC or Acute Cor Pulmonale: Inpatient Reimbursement Overview

    176-PULMONARY-EMBOLISM-WITHOUT-MCC

    Pulmonary Embolism without MCC: Inpatient Reimbursement Overview

    177-RESPIRATORY-INFECTIONS-AND-INFLAMMATIONS-WITH-MCC

    Respiratory Infections and Inflammations with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 40

    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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