Summary & Overview
Major Small and Large Bowel Procedures without CC/MCC: Inpatient Reimbursement Overview
DRG 331 applies to inpatient stays involving major small and large bowel procedures without Complication or Comorbidity or Major Complication or Comorbidity, defining a mid-range surgical complexity payment group. Correct assignment matters for inpatient reimbursement because it determines the standardized Medicare payment for these surgical admissions.
DRG 331 Overview
DRG 331 covers inpatient admissions for major small and large bowel surgical procedures when no Complication or Comorbidity and no Major Complication or Comorbidity are present. Typical cases include resections, anastomoses, or other significant bowel operations performed without documented additional complicating diagnoses. This Diagnosis-Related Group matters because it groups cases of moderate surgical complexity into a standardized Medicare payment category that informs hospital reimbursement. Accurate clinical coding and documentation determine assignment to DRG 331 and thus affect payment.
National Payment Rates
Across commercial payers the reported mean rates for DRG 331 span roughly from $16K (BCBS) up to $28K (Aetna/Cigna), with Anthem and Aetna/Cigna clustered in the mid-to-high $20Ks. The widest spread between payer means is about $12K (BCBS mean $16K vs Cigna/Aetna mean $28K). See the table and chart below for payer-level percentiles and distributions.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 331. These figures summarize nationwide Medicare payment activity for the DRG in 2023.