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    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 415-cholecystectomy-except-by-laparoscope-without-c-d-e-with-cc
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    Cholecystectomy Except by Laparoscope without C.D.E. with CC: Inpatient Reimbursement Overview

    DRG 415 describes inpatient admissions for cholecystectomy performed without laparoscopy or common duct exploration and with a Complication or Comorbidity present, covering increased clinical complexity. It matters for inpatient reimbursement because the Diagnosis-Related Group assignment adjusts Medicare payment to reflect the higher expected resource use associated with these cases.

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    DRG 415 Overview

    DRG 415 covers inpatient hospital admissions for cholecystectomy procedures performed by open or non-laparoscopic approaches without common duct exploration when a Complication or Comorbidity is present. It groups cases where additional clinical complexity increases resource use compared with uncomplicated cholecystectomy, which affects payment relative to lower-severity Diagnosis-Related Groups. Reimbursement under this Diagnosis-Related Group reflects the higher expected costs of care, including longer lengths of stay, greater perioperative management needs, and increased ancillary services. This grouping is used by the Centers for Medicare & Medicaid Services to standardize payment for comparable inpatient resource consumption.

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    Clinical Trials

    • Acute perioperative management trials: studies testing short-term interventions to reduce complications in adults undergoing open (non-laparoscopic) cholecystectomy for acute cholecystitis or gallstone disease with significant comorbidities. These trials enroll patients admitted for urgent or emergent cholecystectomy and evaluate protocols such as optimized fluid management, antibiotic timing/duration, enhanced analgesia strategies, or perioperative risk stratification tools to decrease postoperative infections, cardiopulmonary events, and length of stay. This research is relevant because patients in DRG 415 often have complications (CC) that increase morbidity and resource use, so evidence that lowers in-hospital adverse events directly impacts provider decisions and payer costs.
    • Comparative effectiveness studies of surgical approach and intraoperative techniques: randomized or observational studies comparing open cholecystectomy techniques, surgeon experience levels, use of intraoperative cholangiography, or adjunctive procedures in patients not eligible for laparoscopic surgery. These studies target older or medically complex patients with prior abdominal surgery, severe inflammation, or anatomic variations, aiming to define which operative strategies minimize bile duct injury, reoperation, and transfusion. Findings inform clinical pathways and utilization management by identifying approaches that balance safety, procedure time, and resource utilization for a high-CC population typical of this DRG.
    • Post-discharge outcomes and readmission prevention research: cohort studies and quality-improvement trials evaluating discharge planning, early post-discharge follow-up, rehabilitation referrals, and remote monitoring to reduce 30-day readmissions and late complications after open cholecystectomy in patients with comorbid conditions. These studies focus on those with diabetes, cardiac disease, or prior infections who have higher post-acute needs, measuring functional recovery, complication detection, and cost-effectiveness of transitional care programs. For providers and payers, reducing readmissions and downstream utilization in this DRG improves quality metrics and lowers total episode costs, making these studies highly applicable to discharge and case management decisions.

    Related Codes

    405-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-MCC

    Pancreas, Liver and Shunt Procedures with MCC: Inpatient Reimbursement Overview

    406-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITH-CC

    Pancreas, Liver and Shunt Procedures with CC: Inpatient Reimbursement Overview

    407-PANCREAS-LIVER-AND-SHUNT-PROCEDURES-WITHOUT-CC-MCC

    Pancreas, Liver and Shunt Procedures without CC/MCC: Inpatient Reimbursement Overview

    408-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-MCC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with MCC: Inpatient Reimbursement Overview

    409-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITH-CC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E. with CC: Inpatient Reimbursement Overview

    410-BILIARY-TRACT-PROCEDURES-EXCEPT-ONLY-CHOLECYSTECTOMY-WITH-OR-WITHOUT-C-D-E-WITHOUT-CC-MCC

    Biliary Tract Procedures Except Only Cholecystectomy with or without C.D.E.: Inpatient Reimbursement Overview

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

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

    412-CHOLECYSTECTOMY-WITH-C-D-E-WITH-CC

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

    413-CHOLECYSTECTOMY-WITH-C-D-E-WITHOUT-CC-MCC

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

    414-CHOLECYSTECTOMY-EXCEPT-BY-LAPAROSCOPE-WITHOUT-C-D-E-WITH-MCC

    Cholecystectomy Except by Laparoscope without C.D.E. with MCC: Inpatient Reimbursement Overview

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    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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