Laparoscopic Cholecystectomy without C.D.E. DRG Reimbursement

Summary & Overview

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

DRG 419 applies to inpatient laparoscopic cholecystectomy without common duct exploration and without Complication or Comorbidity or Major Complication or Comorbidity, defining a low-complexity surgical admission. It matters for inpatient reimbursement because Diagnosis-Related Group assignment establishes the bundled Medicare payment and reflects expected resource use for uncomplicated cases.

Laparoscopic CholecystectomyDRG Laparoscopic Cholecystectomy without C.D.E. without CC/MCCDRG 419Diagnosis-Related GroupInpatient ReimbursementMedicareGeneral SurgeryBiliary SurgeryCholecystectomyHospital Coding

DRG 419 Overview

DRG 419 covers inpatient stays for laparoscopic cholecystectomy without common duct exploration and without a Complication or Comorbidity or Major Complication or Comorbidity. This category captures straightforward laparoscopic removal of the gallbladder for biliary disease when no additional surgical exploration or significant comorbid conditions are coded. It matters for Medicare payment because the Diagnosis-Related Group assignment determines the bundled inpatient reimbursement rate and influences hospital resource use classification. Accurate coding of procedures and comorbidities is essential to assign DRG 419 correctly.

National Payment Rates

Across payers, negotiated payments for this DRG range roughly from $370 to $46K, with payer medians typically clustering between about $12K and $23K; the widest spread is from $370 (BCBS minimum) up to $46K (Anthem maximum). See the table and chart below for payer-specific percentiles and mean values for Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

Mean Rates by Payer — National — DRG 419

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 ($11.8k), average submitted covered charges ($70.9k), average Medicare payment amount ($8.9k), and total discharges (8.973k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 419 payer rates span from $21K to a maximum observed $55K across payers, with most payers clustering at $21K while Cigna’s mean of $33K stands out as an outlier on the high end. This produces a wider state range than typical national medians, driven primarily by Cigna’s higher AK rates compared with its national mean. See the table and chart below for payer-level details.

Key Insights for Alaska

Highest-paying payer: Cigna (mean $33K); Lowest-paying payers: Blue Cross Blue Shield and Anthem (both mean $21K).
The state payer range is relatively wide ($21K–$55K max observed) driven by Cigna’s higher upper-end; mean rates in AK (Cigna mean $33K vs national Cigna mean $22K) show Cigna in AK materially above its national average.

Clinical Trials

Acute perioperative optimization trials focusing on enhanced recovery protocols for elective laparoscopic cholecystectomy: these studies evaluate interventions such as standardized multimodal analgesia, opioid-sparing anesthesia techniques, and perioperative fluid management in adult patients admitted for uncomplicated laparoscopic removal of the gallbladder without common bile duct exploration or major comorbidity. The population is typically low-to-moderate risk surgical patients undergoing same-admission laparoscopic cholecystectomy; outcomes include length of stay, postoperative pain scores, complication and readmission rates. This research is relevant to providers and payers because improvements in perioperative pathways can reduce inpatient days, complications, and resource utilization for a high-volume DRG.
Comparative effectiveness trials comparing technical or timing variations in surgical approach and perioperative imaging: these studies might compare early versus delayed laparoscopic cholecystectomy for acute biliary colic without duct exploration, or evaluate routine intraoperative cholangiography versus selective use in otherwise straightforward cases. The focus is on procedural decisions in adult and older adult patients without CC/MCC that could alter operative time, conversion to open surgery, and downstream use of diagnostic or therapeutic biliary procedures. Findings inform provider practice patterns and payer cost-effectiveness assessments by identifying approaches that maintain low complication rates while minimizing additional procedures and hospital resource use.
Post-discharge outcomes and health services research assessing readmissions, outpatient follow-up patterns, and patient-reported recovery after uncomplicated laparoscopic cholecystectomy: these observational cohort studies track short-term readmissions for pain, infection, or retained stones, as well as functional recovery, return-to-work, and postoperative costs across diverse payer populations. The patient population includes those discharged the same day or after a short inpatient stay, often with limited comorbidity, and the research identifies predictors of avoidable readmissions and variations in post-acute care use. Such evidence is important to payers and health systems aiming to optimize discharge planning, reduce preventable readmissions, and align reimbursement and quality metrics for this DRG.

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Summary & Overview

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

DRG 419 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