Summary & Overview
Hepatobiliary Diagnostic Procedures with CC: Inpatient Reimbursement Overview
DRG 421 encompasses inpatient hepatobiliary diagnostic procedures with a Complication or Comorbidity, including diagnostic endoscopic and percutaneous biliary interventions. This classification matters for inpatient reimbursement because it groups cases by expected resource use and adjusts Medicare payment for procedural complexity and comorbid conditions.
DRG 421 Overview
DRG 421 covers inpatient cases centered on hepatobiliary diagnostic procedures, such as diagnostic endoscopic retrograde cholangiopancreatography, percutaneous biliary drainage, and related operative explorations when a Complication or Comorbidity is present. This Diagnosis-Related Group groups patients by resource intensity driven by the diagnostic procedures and the added complexity from Complication or Comorbidity. It matters for Medicare payment because classification into DRG 421 affects hospital reimbursement under the inpatient prospective payment system by reflecting procedure-related resource use and comorbid condition impact. Accurate DRG assignment influences payment level and hospital billing classification within Medicare.
National Payment Rates
Across commercial payers the rate range runs roughly from $370 (BCBS min) up to $63K (Anthem max), with mean/median payer benchmarks clustered in the mid-to-high tens of thousands. The widest spread is seen with Anthem, which shows the largest max ($63K) relative to its min. See the payer table and the chart below for full distribution and percentile detail.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments published 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 421. Values reflect national aggregates for Medicare FFS in 2023.