Summary & Overview
Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device: Inpatient Reimbursement Overview
DRG 426 describes multiple level combined anterior and posterior spinal fusion except cervical with Major Complication or Comorbidity or a custom-made anatomically designed interbody fusion device, encompassing complex multilevel thoracolumbar procedures. It matters for inpatient reimbursement because it captures high-resource cases into a higher-weighted payment category under Centers for Medicare & Medicaid Services billing rules.
DRG 426 Overview
DRG 426 covers multiple level combined anterior and posterior spinal fusion procedures excluding the cervical spine when performed with a Major Complication or Comorbidity or with a custom-made anatomically designed interbody fusion device. These cases represent complex multilevel thoracic or lumbosacral reconstructions that typically require extended operative time, advanced instrumentation, and higher resource utilization. For Medicare inpatient reimbursement, this Diagnosis-Related Group groups higher-cost patients into a higher-weighted payment category under Centers for Medicare & Medicaid Services rules. Accurate coding of procedures and comorbidities determines eligibility for this Diagnosis-Related Group and affects hospital payment.