Summary & Overview
Other Hepatobiliary or Pancreas O.R. Procedures with MCC: Inpatient Reimbursement Overview
DRG 423 pertains to other hepatobiliary or pancreas operating room procedures accompanied by a Major Complication or Comorbidity and reflects higher clinical severity for inpatient surgical cases. This grouping matters for inpatient reimbursement because the elevated severity classification increases the payment weight under Centers for Medicare & Medicaid Services hospital payment policies.
DRG 423 Overview
DRG 423 covers inpatient cases involving other hepatobiliary or pancreas operating room procedures when a Major Complication or Comorbidity is present. Typical cases include complex biliary, hepatic, or pancreatic operative interventions with significant comorbid conditions or acute complications that increase resource use. This Diagnosis-Related Group matters for Medicare payment because the presence of a Major Complication or Comorbidity raises the relative weight and reimbursement relative to otherwise similar procedures without such severity. Accurate clinical documentation and coding of the principal procedure and Major Complication or Comorbidity directly affect inpatient reimbursement under Centers for Medicare & Medicaid Services payment rules.
National Payment Rates
Across commercial payers, negotiated rates for DRG 423 range from about $37K (BCBS median) up to $68K (Cigna mean), with payer medians and means varying by carrier. The widest spread between payer medians in the provided benchmarks is roughly $50K (BCBS median ~$37K versus Anthem median ~$63K). See the table and chart below for payer-level detail and percentile ranges.
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 ($41.3k), average submitted covered charges ($206.8k), average Medicare payment ($34.4k), and total discharges (1.5k).