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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Hepatobiliary System and PancreasDRG 445-disorders-of-the-biliary-tract-with-cc
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    Disorders of the Biliary Tract with CC: Inpatient Reimbursement Overview

    DRG 445 captures inpatient admissions for disorders of the biliary tract accompanied by at least one Complication or Comorbidity, affecting clinical complexity and resource use. This distinction matters for inpatient reimbursement because it alters Diagnosis-Related Group assignment and the Centers for Medicare & Medicaid Services payment weight applied to the stay.

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    DRG 445 Overview

    DRG 445 covers inpatient cases involving disorders of the biliary tract that include at least one Complication or Comorbidity. This grouping encompasses diagnoses such as cholecystitis, choledocholithiasis, and other biliary obstructions when accompanied by additional complicating conditions. It matters for Medicare payment because presence of a Complication or Comorbidity increases relative resource use and influences the Diagnosis-Related Group assignment and resulting inpatient reimbursement. Accurate coding of the primary biliary diagnosis and any Complication or Comorbidity is essential for correct payment classification.

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    Clinical Trials

    • Acute interventional studies evaluating endoscopic and percutaneous management strategies for obstructive biliary tract disorders: randomized or pragmatic trials compare timing and technique of urgent biliary decompression (eg, early vs delayed ERCP, or ERCP vs percutaneous drainage) in hospitalized adults with acute cholangitis or biliary obstruction complicated by sepsis or organ dysfunction. These studies enroll the typical inpatient DRG 445 population—older adults with acute biliary infections or obstruction and at least one complication or comorbidity—and measure short-term outcomes such as time to source control, length of stay, intensive care needs, and in-hospital mortality. Results directly inform inpatient clinical pathways and resource use, so they are highly relevant to providers optimizing acute care and to payers concerned with cost, readmission risk, and DRG-based reimbursement.
    • Comparative effectiveness and procedural outcomes research for surgical versus endoscopic management in complicated biliary disease: cohort studies and pragmatic randomized trials assess outcomes of cholecystectomy (laparoscopic or open) performed during the same admission versus delayed elective surgery, or compare surgical bile duct exploration to endoscopic stone removal in patients with choledocholithiasis and complications. Patient cohorts reflect those captured under DRG 445—patients with biliary tract disorders plus complications or comorbidities—and focus on perioperative morbidity, complication rates (eg, bile leak, wound infection), need for repeat procedures, and total inpatient costs. These studies help clinicians and hospital systems decide optimal timing and modality of definitive treatment, and help payers evaluate value across pathways that affect LOS and downstream utilization under bundled or DRG payment models.
    • Post-discharge outcomes and quality-of-care studies examining readmission, complications, and long-term recovery after complicated biliary admissions: observational and registry-based research tracks rates and causes of 30- and 90-day readmission, outpatient procedure needs, persistent biliary symptoms, and functional recovery in patients discharged after an admission for biliary tract disorders with complications. These studies often stratify by index management (eg, source control method, inpatient antibiotic duration, comorbidity burden) to identify modifiable factors associated with better post-discharge outcomes and reduced utilization. Findings inform discharge planning, transitional care interventions, and payer strategies to reduce preventable readmissions and improve value for the DRG 445 population.

    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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