Cholecystectomy with C.D.E. without CC/MCC DRG Reimbursement

Summary & Overview

Cholecystectomy with C.D.E. without CC/MCC: Inpatient Reimbursement Overview

DRG 413 encompasses cholecystectomy with common duct exploration without Complication or Comorbidity or Major Complication or Comorbidity and represents a defined surgical cohort for inpatient claims. Accurate coding of the cholecystectomy, common duct exploration, and absence of Complication or Comorbidity or Major Complication or Comorbidity is essential because it affects Diagnosis-Related Group assignment and Medicare inpatient reimbursement.

Cholecystectomy with C.D.E. without CC/MCCDRG Cholecystectomy with C.D.E. without CC/MCCDRG 413Diagnosis-Related GroupInpatient ReimbursementMedicareGeneral SurgeryHepatobiliary SurgeryBile Duct Exploration

DRG 413 Overview

DRG 413 covers inpatient admissions for cholecystectomy with common duct exploration without Complication or Comorbidity or Major Complication or Comorbidity. It includes surgical management of gallbladder disease when a common bile duct procedure is performed and no additional Complication or Comorbidity or Major Complication or Comorbidity is coded. This Diagnosis-Related Group matters for Medicare inpatient payment because it groups cases with similar resource use for prospective payment. Correct coding of procedures and principal diagnosis determines assignment to this Diagnosis-Related Group and influences reimbursement.

National Payment Rates

Across commercial payers the observed rate range runs from about $15K (BCBS minimum) up to $62K (Anthem maximum), with mean payer rates clustering between $15K and $27K. The widest spread appears between Anthem (max $62K) and BCBS (min $15K). See the table and chart below for payer‑level detail and distribution.

Mean Rates by Payer — National — DRG 413

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 ($14.4k), average submitted covered charges ($82.1k), average Medicare payment ($11.3k), and total discharges (107) for DRG 413.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

In Alaska, DRG 413 payments range from roughly $7.5K at the low end to about $71K at the high end across payers, with state medians clustering near $26K for BCBS/Anthem and about $40K for Cigna. Cigna stands out as the notable deviation from broader national patterns, paying substantially higher medians and maximums in this state. Reference the table and chart below for payer-level distributions and percentiles.

Key Insights for Alaska

Highest payer: Cigna (median $40K; max $71K) — pays materially above other local payers.
Lowest payer: BCBS/Anthem (median $26K; min $7.5K) — clustered at lower end of the state range.
Alaska’s payers skew higher than national medians for some payers (notably Cigna’s median ~ $40K versus national medians around $25–$28K), while BCBS/Anthem in AK align with or slightly above national medians for those payers.

Clinical Trials

Perioperative analgesia and opioid-sparing protocols: randomized and pragmatic clinical studies evaluating multimodal analgesic regimens, regional anesthesia (e.g., nerve blocks), or non-opioid medications during and immediately after laparoscopic cholecystectomy with common duct exploration. These trials enroll adult inpatients undergoing cholecystectomy with CDE to quantify pain control, opioid consumption, complication rates, and length of stay. Results inform providers on safer, recovery-accelerating anesthesia strategies and help payers anticipate resource use and readmission risk tied to perioperative pain management.
Comparative effectiveness of surgical approaches and intraoperative imaging strategies: prospective cohort studies and randomized trials comparing laparoscopic versus mini-open approaches, single- versus multi-port techniques, or the use of routine intraoperative cholangiography/fluoroscopy versus selective imaging during cholecystectomy with CDE. These studies focus on operative time, bile duct injury, retained stones, conversion rates, and short-term morbidity in typical adult surgical populations with gallstone disease and common bile duct stones. Evidence from this research guides surgeons on technique choices that reduce complications and re-interventions, and provides payers with data on procedure-related costs and downstream utilization.
Post-discharge recovery, complication surveillance, and health services outcomes: observational studies and registry analyses tracking readmissions, postoperative infections, retained stone management, functional recovery, and patient-reported outcomes for 30–90 days after discharge following cholecystectomy with CDE. These investigations target real-world patients including older adults and those with comorbidities to identify predictors of adverse outcomes and resource-intensive post-acute care needs. Findings are relevant to hospital quality improvement, discharge planning, and payer assessments of bundled payments or case-mix adjustments based on risk of post-discharge utilization.

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436-MALIGNANCY-OF-HEPATOBILIARY-SYSTEM-OR-PANCREAS-WITH-CC

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411-CHOLECYSTECTOMY-WITH-C-D-E-WITH-MCC

Cholecystectomy with C.D.E. with MCC: Inpatient Reimbursement Overview

432-CIRRHOSIS-AND-ALCOHOLIC-HEPATITIS-WITH-MCC

Cirrhosis and Alcoholic Hepatitis with MCC: Inpatient Reimbursement Overview

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Other Hepatobiliary or Pancreas O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

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Cholecystectomy with Common Duct Exploration with Complication or Comorbidity: Inpatient Reimbursement Overview

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OpenPayer

Summary & Overview

Cholecystectomy with C.D.E. without CC/MCC: Inpatient Reimbursement Overview

DRG 413 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