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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 436-malignancy-of-hepatobiliary-system-or-pancreas-with-cc
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    Malignancy of Hepatobiliary System or Pancreas with CC: Inpatient Reimbursement Overview

    DRG 436 addresses inpatient admissions for malignancy of the hepatobiliary system or pancreas with a Complication or Comorbidity and reflects moderate clinical complexity. It matters for inpatient reimbursement because assignment to this Diagnosis-Related Group affects Medicare payment based on the documented severity and resource use during the hospital stay.

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    DRG 436 Overview

    DRG 436 covers hospital inpatient stays for malignancies of the hepatobiliary system or pancreas when a Complication or Comorbidity is present. These cases typically involve complex surgical, medical oncology, and interventional procedures with extended resource use. This Diagnosis-Related Group influences Medicare payment by grouping clinical severity and resource intensity into a single payment classification for acute inpatient reimbursement. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and therefore impact payment levels.

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    Clinical Trials

    • Neoadjuvant and perioperative therapy trials assessing systemic chemotherapy and/or radiotherapy strategies for borderline-resectable and locally advanced hepatobiliary and pancreatic malignancies. These studies enroll patients admitted for initial staging or preoperative treatment to evaluate tumor downstaging, resectability rates, pathologic response, and short-term perioperative morbidity. Results inform surgical candidacy, length of stay, ICU needs, and downstream costs relevant to inpatient reimbursement and DRG assignment.
    • Comparative effectiveness studies of endoscopic, percutaneous, and surgical biliary drainage and decompression in patients admitted with obstructive jaundice or cholangitis due to hepatobiliary or pancreatic cancer. Trials and pragmatic studies compare clinical outcomes (infection resolution, need for reintervention, procedure-related complications), timing of definitive oncologic therapy, and resource utilization across modalities and patient risk profiles. Findings are directly applicable to inpatient care pathways, influencing procedure selection, complication rates coded as CCs, and payer considerations for cost-effective management.
    • Post-discharge outcomes and palliative care integration cohort studies focused on readmissions, symptom control, and survival among patients with advanced hepatobiliary or pancreatic cancer who had inpatient stays for complications or initial therapy. These observational and interventional studies examine transitions of care, hospice/palliative involvement, and predictors of early readmission or high-cost utilization, helping hospitals and payers design discharge planning, case management, and value-based payment strategies to reduce avoidable inpatient utilization.

    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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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.