Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of the Digestive SystemDRG 326-stomach-esophageal-and-duodenal-procedures-with-mcc
    Ask Trek AI about this page

    Stomach, Esophageal and Duodenal Procedures with MCC: Inpatient Reimbursement Overview

    DRG 326 encompasses major stomach, esophageal, and duodenal procedures with a Major Complication or Comorbidity and indicates high clinical complexity. It matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases the relative payment weight under Medicare Severity Diagnosis-Related Group payment policies.

    Customize your policy alerts

    Sign up for drg 326 policy alerts

    Get alerted when payer policies referencing 326 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 326 Overview

    DRG 326 covers inpatient admissions for major stomach, esophageal, and duodenal procedures when a Major Complication or Comorbidity is present. Cases typically involve complex surgical interventions such as gastrectomy, esophagectomy, or extensive duodenal surgery with significant perioperative resource use. This Diagnosis-Related Group matters for Medicare payment because the presence of a Major Complication or Comorbidity increases the relative resource intensity and reimbursement weight compared with lower-severity groups. Accurate coding of procedures and comorbid conditions is essential to assign the appropriate Medicare Severity Diagnosis-Related Group and reflect expected inpatient costs.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical Trials

    • Acute perioperative intervention trials evaluating surgical techniques, anesthesia protocols, or enhanced recovery pathways for patients undergoing complex stomach, esophageal, or duodenal operations with major complications (MCC). These studies enroll primarily inpatient adults who require procedures such as gastrectomy, esophagectomy, or complex repair for perforation/bleeding and test interventions aimed at reducing intraoperative blood loss, intra‑abdominal sepsis, or cardiopulmonary complications. Results are directly relevant to clinicians and hospital managers because they can lower ICU stays, transfusion needs, and complication-related costs that drive higher reimbursements under this DRG.
    • Comparative effectiveness studies comparing laparoscopic, minimally invasive, or open surgical approaches and adjunctive therapies for high‑risk patients with malignant or complicated benign disease of the stomach, esophagus, or duodenum. These trials typically include older patients, those with significant comorbidities, or those presenting emergently with obstruction, perforation, or hemorrhage, and assess outcomes such as complication rates, readmissions, and functional recovery. Payers and provider networks rely on this evidence to inform procedure selection, case mix adjustments, and resource allocation because differences in outcomes affect length of stay and downstream costs under the DRG.
    • Post‑discharge outcomes and care‑coordination studies examining readmission prevention, nutritional rehabilitation, and long‑term quality of life after index hospitalization for complex upper GI procedures with MCC. These observational cohorts or pragmatic trials follow patients after discharge to study drivers of early readmission, malnutrition, or persistent functional impairment and to evaluate transitional care interventions like targeted outpatient nutrition support or home health. Findings help hospitals and payers develop discharge strategies and bundled payment models to reduce costly readmissions and optimize recovery metrics tied to reimbursement and performance benchmarks.

    Related Codes

    327-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITH-CC

    Stomach, Esophageal and Duodenal Procedures with CC: Inpatient Reimbursement Overview

    328-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITHOUT-CC-MCC

    Stomach, Esophageal and Duodenal Procedures without CC/MCC: Inpatient Reimbursement Overview

    329-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITH-MCC

    Major Small and Large Bowel Procedures with MCC: Inpatient Reimbursement Overview

    330-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITH-CC

    Major Small and Large Bowel Procedures with CC: Inpatient Reimbursement Overview

    331-MAJOR-SMALL-AND-LARGE-BOWEL-PROCEDURES-WITHOUT-CC-MCC

    Major Small and Large Bowel Procedures without CC/MCC: Inpatient Reimbursement Overview

    332-RECTAL-RESECTION-WITH-MCC

    Rectal Resection with MCC: Inpatient Reimbursement Overview

    333-RECTAL-RESECTION-WITH-CC

    Rectal Resection with CC: Inpatient Reimbursement Overview

    334-RECTAL-RESECTION-WITHOUT-CC-MCC

    Rectal Resection without CC/MCC: Inpatient Reimbursement Overview

    335-PERITONEAL-ADHESIOLYSIS-WITH-MCC

    Peritoneal Adhesiolysis with MCC: Inpatient Reimbursement Overview

    336-PERITONEAL-ADHESIOLYSIS-WITH-CC

    Peritoneal Adhesiolysis with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 57

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    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.