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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Digestive SystemDRG 389-gastrointestinal-obstruction-with-cc
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    Gastrointestinal Obstruction with CC: Inpatient Reimbursement Overview

    DRG 389 addresses inpatient admissions for gastrointestinal obstruction with a Complication or Comorbidity and includes conditions such as mechanical obstruction and paralytic ileus that increase clinical complexity. It matters for inpatient reimbursement because the Complication or Comorbidity status raises resource use and affects payment under the Medicare inpatient prospective payment framework.

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    DRG 389 Overview

    DRG 389 covers inpatient stays for patients treated for gastrointestinal obstruction when a Complication or Comorbidity is present. Typical clinical issues include mechanical bowel obstruction, paralytic ileus, and related metabolic or infectious complications that require inpatient management. This Diagnosis-Related Group matters for Medicare payment because the presence of a Complication or Comorbidity adjusts relative resource intensity and influences reimbursement under the inpatient prospective payment system. Accurate clinical documentation and coding drive correct assignment to this Diagnosis-Related Group and its payment implications.

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    National Payment Rates

    Across payers the observed rate range spans roughly from $370 up to $31K, with payer medians generally between about $7.7K and $14K; the widest spread appears in the Anthem dataset (min $390 to max $31K). See the table and chart below for payer-level distributions and interquartile ranges. Payer comparisons include Blue Cross Blue Shield, Aetna, Anthem, and Cigna.

    The CMS 2023 figures are national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($7.6k), average submitted covered charges ($37.2k), average Medicare payment amount ($5.6k), and total discharges (37.6k), reflecting national aggregates for Medicare FFS inpatient claims.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $7.6K$37K$5.6K38K

    Patient Population

    This DRG’s admissions include a mix of Medicare-age and working-age patients, but administrative inpatient volumes tend to skew toward Medicare beneficiaries. The presence of a substantial Medicare caseload reflects that many discharges are from the Medicare-age population, while commercial payers also represent a meaningful share of events. Overall, the cohort is mixed but leans toward Medicare-age patients.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 389, mean rates range from $12K to $19K, with Cigna showing the highest mean and the widest range (up to $32K) while Anthem and Blue Cross Blue Shield sit at the low end with flat $12K means. This distribution represents a noteworthy upward deviation versus national median levels for comparable payers, particularly for Cigna. See the table and chart below for payer-level details.

    Key Insights for Alaska

    • Highest payer: Cigna (mean $19K, max $32K); Lowest payer: Anthem and Blue Cross Blue Shield (mean $12K).
    • Alaska’s mean rates skew higher than national medians for the listed payers, with Cigna notably exceeding national Cigna benchmarks and exhibiting a wide spread up to $32K.

    Clinical Trials

    • Acute procedural intervention trials: Studies evaluating timing, technique, and perioperative management of urgent endoscopic or surgical procedures for hospitalized patients with mechanical or functional gastrointestinal obstruction. These trials typically enroll adult inpatients presenting with obstructive symptoms due to adhesions, hernias, tumors, volvulus, or ileus and compare immediate endoscopic decompression versus early operative repair, or variations in minimally invasive versus open approaches. Findings are directly relevant to providers and payers because they inform resource utilization, complication rates, length of stay, and intensity of inpatient care associated with DRG 389 admissions.
    • Comparative effectiveness studies of nonoperative management strategies: Research comparing conservative inpatient treatments — such as bowel rest, nasogastric decompression, intravenous fluid/electrolyte protocols, and use of prokinetic or antiemetic agents — across different patient subgroups (for example elderly, immunocompromised, or those with partial obstruction). These studies focus on which patient characteristics predict successful nonoperative resolution versus need for escalation to procedural intervention, helping clinicians triage care and helping payers predict costs and avoidable procedures. Results help refine clinical pathways that can reduce complications, readmissions, and variation in reimbursement-intensive services within this DRG.
    • Post-discharge outcomes and readmission prevention studies: Cohort and interventional studies assessing discharge readiness, outpatient follow-up models, nutrition support (including timing of enteral feeding), and rehabilitation to prevent readmission and late complications among patients who were hospitalized with gastrointestinal obstruction and had a CC. These investigations target risk factors for 30- and 90-day readmission, long-term functional recovery, and transitions of care, providing evidence for post-acute care planning and bundled-payment strategies that affect total cost of care and quality metrics for providers and payers managing DRG 389 cases.

    Related Codes

    326-STOMACH-ESOPHAGEAL-AND-DUODENAL-PROCEDURES-WITH-MCC

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

    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

    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.
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    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.

    Mean Rates by Payer — National — DRG 389
    Mean Rates by Payer — Alaska — DRG 389