Summary & Overview

Gastrointestinal Hemorrhage with CC: Inpatient Reimbursement Overview

DRG 378 addresses inpatient admissions for gastrointestinal hemorrhage with a Complication or Comorbidity, defining the clinical scope for cases with additional complexity that increase resource use. Correct assignment impacts Medicare payment because the Diagnosis-Related Group determines bundled reimbursement for the hospital stay under Centers for Medicare & Medicaid Services grouping rules.

Gastrointestinal HemorrhageDRG Gastrointestinal Hemorrhage with CCDRG 378Diagnosis-Related GroupInpatient ReimbursementMedicareGastroenterologyEndoscopyHospital CodingClinical Documentation

DRG 378 Overview

DRG 378 covers hospital inpatient cases for gastrointestinal bleeding when a Complication or Comorbidity is present. Typical clinical examples include upper or lower gastrointestinal hemorrhage with associated conditions that increase resource use, such as anemia or anticoagulation management. This Diagnosis-Related Group matters for Medicare payment because it groups clinically similar cases to determine bundled reimbursement based on expected resource consumption during the inpatient stay. Accurate coding of the bleeding diagnosis and any Complication or Comorbidity influences the payment classification under Centers for Medicare & Medicaid Services rules.

National Payment Rates

Across payers the observed mean payment benchmarks range from about $9.3K (BCBS) to $16K (Cigna and Aetna), with payer-level medians spanning roughly $9.3K to $17K; the full range across the sample runs approximately $370 up to $36K. The widest spread is seen with Anthem (min $390 to max $36K), indicating substantial variability in negotiated rates; see the table and chart below for payer-level percentiles. Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem are shown in the visuals.

Mean Rates by Payer — National — DRG 378

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 378 payer means range from $15K (Blue Cross Blue Shield and Anthem) up to $24K (Cigna), with observed payments spanning $15K–$39K across payers. The most notable deviation from national averages is Cigna’s higher mean and upper tail, producing a substantially larger max ($39K) than typical national maxima. See the table and chart below for payer-specific percentiles and distribution.

Key Insights for Alaska

Highest payer: Cigna (mean $24K); Lowest payers: BCBS and Anthem (both mean $15K).
Alaska’s rate range is relatively wide ($15K–$39K) driven by Cigna’s higher max and mean, representing a meaningful upward deviation versus national medians where most payers cluster around $15K–$17K.

Clinical Trials

Acute hemostatic intervention trials: randomized or controlled studies evaluating endoscopic, interventional radiology, or pharmacologic strategies to achieve rapid control of active gastrointestinal bleeding in hospitalized patients. These studies typically enroll patients admitted with upper or lower GI hemorrhage who have hemodynamic instability or high-risk stigmata on endoscopy, and compare time-to-hemostasis, transfusion requirements, and in-hospital complications across interventions. Findings inform inpatient clinical pathways, resource utilization (e.g., need for ICU, repeat procedures), and short-term reimbursement implications tied to length of stay and procedure coding.
Comparative effectiveness and risk-stratification studies in anticoagulated or comorbid populations: observational cohort studies or pragmatic trials assessing different management algorithms for patients on antithrombotic therapy or with significant comorbidities (cardiovascular disease, renal failure, cirrhosis) who present with GI bleeding. Research questions include optimal timing of anticoagulation reversal or resumption, risk prediction of rebleeding versus thrombotic events, and tailoring endoscopic approaches in higher-risk groups. Results are relevant to clinicians and payers because they affect readmission risk, rates of CC/MCC capture, and decisions about monitoring intensity and discharge planning that drive inpatient costs.
Post-discharge outcomes and care-transition studies: prospective studies or quality-improvement trials testing interventions such as structured follow-up, outpatient endoscopy scheduling, or medication reconciliation to reduce readmissions and late rebleeding after an inpatient stay for gastrointestinal hemorrhage. These studies enroll survivors of an index hospitalization (often older adults with multiple comorbidities) and measure 30–90 day readmission, outpatient procedure completion, and patient-centered outcomes like functional status. Evidence from this research guides resource allocation for discharge planning, case management, and bundled-payment models by demonstrating which post-acute strategies lower downstream utilization and improve value for payers and providers.

Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$9K	$46K	$7.1K	83K

Acute hemostatic intervention trials: randomized or controlled studies evaluating endoscopic, interventional radiology, or pharmacologic strategies to achieve rapid control of active gastrointestinal bleeding in hospitalized patients. These studies typically enroll patients admitted with upper or lower GI hemorrhage who have hemodynamic instability or high-risk stigmata on endoscopy, and compare time-to-hemostasis, transfusion requirements, and in-hospital complications across interventions. Findings inform inpatient clinical pathways, resource utilization (e.g., need for ICU, repeat procedures), and short-term reimbursement implications tied to length of stay and procedure coding.
Comparative effectiveness and risk-stratification studies in anticoagulated or comorbid populations: observational cohort studies or pragmatic trials assessing different management algorithms for patients on antithrombotic therapy or with significant comorbidities (cardiovascular disease, renal failure, cirrhosis) who present with GI bleeding. Research questions include optimal timing of anticoagulation reversal or resumption, risk prediction of rebleeding versus thrombotic events, and tailoring endoscopic approaches in higher-risk groups. Results are relevant to clinicians and payers because they affect readmission risk, rates of CC/MCC capture, and decisions about monitoring intensity and discharge planning that drive inpatient costs.
Post-discharge outcomes and care-transition studies: prospective studies or quality-improvement trials testing interventions such as structured follow-up, outpatient endoscopy scheduling, or medication reconciliation to reduce readmissions and late rebleeding after an inpatient stay for gastrointestinal hemorrhage. These studies enroll survivors of an index hospitalization (often older adults with multiple comorbidities) and measure 30–90 day readmission, outpatient procedure completion, and patient-centered outcomes like functional status. Evidence from this research guides resource allocation for discharge planning, case management, and bundled-payment models by demonstrating which post-acute strategies lower downstream utilization and improve value for payers and providers.

OpenPayer

Summary & Overview

Gastrointestinal Hemorrhage with CC: Inpatient Reimbursement Overview

DRG 378 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes