Coronary Bypass without Cardiac Catheterization with MCC DRG Reimbursement

DRG 235 encompasses coronary artery bypass graft procedures without cardiac catheterization when a Major Complication or Comorbidity is present, indicating higher clinical complexity. This Diagnosis-Related Group matters for inpatient reimbursement because the Major Complication or Comorbidity designation elevates the payment relative to less complex coronary bypass cases.

DRG 235 Overview

DRG 235 covers inpatient stays for patients undergoing coronary artery bypass grafting without cardiac catheterization who have at least one Major Complication or Comorbidity. This Diagnosis-Related Group captures higher resource use linked to severe comorbid illness or major postoperative complications, which increases case weight and Medicare payment. Hospitals and billing teams monitor DRG 235 because payer reimbursement and resource allocation are influenced by the presence of Major Complication or Comorbidity. Payment for this Diagnosis-Related Group reflects the intensity of care required during the indexed hospitalization.

DRG 235 Overview

Across payers the observed rate range runs from about $370 (BCBS minimum) up to $210K (Anthem maximum), with mean payer-level averages spanning roughly $52K to $96K. The widest spread in reported values is between the lowest observed minimum ($370) and the highest maximum ($210K). Refer to the table and chart below for payer-specific percentiles and distribution details for Cigna, BCBS, Aetna, and Anthem.

The CMS 2023 data shown below represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table columns display average total payment ($54.5k), average submitted covered charges ($279.1k), average Medicare payment ($44.6k), and total discharges (11.3k).

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$54K	$280K	$45K	11K

Patient Population

This DRG’s population mixes Medicare-age and working-age patients but skews toward Medicare-age beneficiaries given the typical payer mix for complex inpatient DRGs. Private/commercial payers (e.g., Blue Cross Blue Shield, Cigna, Aetna, Anthem) still account for a meaningful portion of cases, resulting in a mixed-age profile. Overall, the cohort leans toward Medicare-age patients rather than being primarily working-age.

Alaska Benchmarks

In Alaska for DRG 235, mean rates span from $91K to $140K across payers, with BCBS and Anthem at the low end and Cigna substantially higher. The state’s payer mix shows a notable upward deviation driven by Cigna versus national averages, which cluster below Cigna’s $140K mean. See the table and chart below for payer-level details.

Key Insights for Alaska

Highest payer: Cigna at $140K mean; lowest payers: BCBS and Anthem both at $91K mean.
AK’s mean range ($91K–$140K) is skewed high by Cigna relative to national means, where typical means cluster lower around $80K–$96K.

Acute perioperative intervention trials: randomized or pragmatic studies testing intraoperative and immediate postoperative strategies to reduce complications in patients undergoing isolated coronary artery bypass grafting (CABG) with major complications or comorbidities (the MCC population). Examples of research questions include optimization of cardiopulmonary bypass techniques, myocardial protection strategies, transfusion thresholds, and protocols to prevent perioperative stroke, acute kidney injury, or severe bleeding. This research is relevant because reducing early complications can shorten ICU and hospital length of stay, lower resource use, and directly impact DRG payment variance for high-cost cases.
Comparative effectiveness studies of conduit selection and grafting strategies in high-risk patients: observational cohort studies or randomized trials comparing outcomes of arterial versus venous graft use, on- versus off-pump CABG, or hybrid approaches specifically in patients with significant comorbidities (for example diabetes, renal dysfunction, or prior cerebrovascular disease) who qualify as MCC. These studies address which surgical strategies most improve survival, reduce repeat revascularization, and minimize major complications in the complex patients typical of this DRG, informing surgeons and hospital programs about best practices that affect readmission rates and downstream costs.
Post-discharge outcomes and care-transition research: prospective studies and quality-improvement trials evaluating discharge planning, cardiac rehabilitation uptake, medication adherence support, and remote monitoring to reduce readmissions and long-term morbidity in CABG patients who experienced major perioperative complications. By focusing on the high-risk MCC cohort, these trials examine interventions that can prevent early readmissions, improve functional recovery, and optimize use of outpatient resources — outcomes directly tied to payer cost-containment and hospital performance metrics under bundled-payment and value-based programs.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$54K	$280K	$45K	11K

Patient Population

Alaska Benchmarks

Key Insights for Alaska

Highest payer: Cigna at $140K mean; lowest payers: BCBS and Anthem both at $91K mean.
AK’s mean range ($91K–$140K) is skewed high by Cigna relative to national means, where typical means cluster lower around $80K–$96K.

Acute perioperative intervention trials: randomized or pragmatic studies testing intraoperative and immediate postoperative strategies to reduce complications in patients undergoing isolated coronary artery bypass grafting (CABG) with major complications or comorbidities (the MCC population). Examples of research questions include optimization of cardiopulmonary bypass techniques, myocardial protection strategies, transfusion thresholds, and protocols to prevent perioperative stroke, acute kidney injury, or severe bleeding. This research is relevant because reducing early complications can shorten ICU and hospital length of stay, lower resource use, and directly impact DRG payment variance for high-cost cases.
Comparative effectiveness studies of conduit selection and grafting strategies in high-risk patients: observational cohort studies or randomized trials comparing outcomes of arterial versus venous graft use, on- versus off-pump CABG, or hybrid approaches specifically in patients with significant comorbidities (for example diabetes, renal dysfunction, or prior cerebrovascular disease) who qualify as MCC. These studies address which surgical strategies most improve survival, reduce repeat revascularization, and minimize major complications in the complex patients typical of this DRG, informing surgeons and hospital programs about best practices that affect readmission rates and downstream costs.
Post-discharge outcomes and care-transition research: prospective studies and quality-improvement trials evaluating discharge planning, cardiac rehabilitation uptake, medication adherence support, and remote monitoring to reduce readmissions and long-term morbidity in CABG patients who experienced major perioperative complications. By focusing on the high-risk MCC cohort, these trials examine interventions that can prevent early readmissions, improve functional recovery, and optimize use of outpatient resources — outcomes directly tied to payer cost-containment and hospital performance metrics under bundled-payment and value-based programs.

OpenPayer

Coronary Bypass without Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

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DRG 235 Overview

OpenPayer

Coronary Bypass without Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

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DRG 235 Overview

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References

National Payment Rates

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

References