Gastrointestinal Obstruction without CC/MCC DRG Reimbursement

Summary & Overview

Gastrointestinal Obstruction without CC/MCC: Inpatient Reimbursement Overview

DRG 390 addresses inpatient admissions for gastrointestinal obstruction without Complication or Comorbidity or Major Complication or Comorbidity, encompassing cases managed conservatively or with limited procedures. It matters for inpatient reimbursement because it groups similar resource use and severity to set Medicare payment under the inpatient prospective payment system.

Gastrointestinal Obstruction without CC/MCCDRG Gastrointestinal Obstruction without CC/MCCDRG 390Diagnosis-Related GroupInpatient ReimbursementMedicareGeneral SurgeryGastroenterologyHospital CodingInpatient Prospective Payment System

DRG 390 Overview

DRG 390 covers hospital admissions for gastrointestinal obstruction without Complication or Comorbidity or Major Complication or Comorbidity. Typical cases include small bowel or large bowel obstructions managed medically or with limited procedural intervention when no significant comorbid conditions are present. This Diagnosis-Related Group is used to classify severity and determine inpatient prospective payment amounts under Medicare. Correct DRG assignment influences hospital reimbursement and reflects resource use for straightforward obstruction cases.

National Payment Rates

Across payers, negotiated rates for DRG 390 range from about $370 to $22K, with payer medians clustered between roughly $5.4K and $9.9K. The widest spread is between BCBS (min/max roughly $370–$16K) and Anthem (min/max roughly $390–$22K), reflecting substantial variation in high-end contractual rates. See the table and chart below for payer-specific distributions and percentile details.

Mean Rates by Payer — National — DRG 390

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 390. Values are presented as national aggregates for the reporting year.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 390 rates cluster between $8.5K and $13K across payers, with Blue Cross Blue Shield reporting a uniform $8.5K and Cigna showing a median around $13K and a max up to $22K. The spread reflects a compact low end dominated by Blue Cross Blue Shield and Anthem at $8.5K, while Cigna meaningfully exceeds national medians with its higher center and upper tail. See the table and chart below for payer-level detail.

Key Insights for Alaska

Anthem is the highest paying payer in Alaska (median ~$13K) while Blue Cross Blue Shield is the lowest (uniform $8.5K).
Cigna’s median (~$13K) and wider range up to $22K represent a meaningful upside versus national medians, indicating notable deviation above national average rates.

Clinical Trials

Acute procedural and device intervention trials assessing endoscopic and minimally invasive techniques for relieving bowel obstruction: studies focus on comparing outcomes of urgent endoscopic decompression, stent placement, or laparoscopic adhesiolysis versus open surgical approaches in adults hospitalized with small or large bowel obstruction without major complications (no CC/MCC). These trials enroll patients presenting with acute obstructive symptoms requiring immediate intervention to determine procedural success rates, time to oral intake, and short-term safety. Results inform providers on procedure selection and timing, and help payers evaluate resource utilization, length of stay, and cost-effectiveness of less invasive approaches in this DRG.
Comparative effectiveness studies of nonoperative management strategies in patients with partial obstruction or adhesive small bowel obstruction: research compares outcomes of structured conservative care pathways (nasogastric decompression, bowel rest, IV fluids, and standardized monitoring) against early surgical intervention in hemodynamically stable patients without major comorbidities. These studies target the common inpatient population coded to this DRG to identify predictors of nonoperative success, rates of eventual surgery, and complication profiles. Findings guide clinicians on patient selection for conservative care and help payers anticipate readmission risk, inpatient resource needs, and avoidable surgeries.
Post-discharge outcomes and care-coordination studies examining recovery, readmission, and rehabilitation needs after hospitalization for gastrointestinal obstruction without CC/MCC: observational cohorts and interventional care-transition studies evaluate discharge planning, outpatient follow-up strategies, and patient education interventions aimed at reducing 30- and 90-day readmissions and optimizing functional recovery. They enroll patients discharged after noncomplicated obstruction management to assess predictors of recurrent obstruction, medication and diet adherence, and quality of life. This research is relevant to providers and payers by identifying high-risk patients for targeted interventions, informing outpatient resource allocation, and supporting value-based reimbursement models focused on reducing avoidable return hospitalizations.

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$5.7K	$27K	$3.5K	18K