Summary & Overview
Spinal Fusion Except Cervical with MCC: Inpatient Reimbursement Overview
DRG 456 covers noncervical spinal fusion procedures performed for spinal curvature, malignancy, infection, or extensive multilevel fusions when a Major Complication or Comorbidity is present, reflecting high clinical complexity. This group matters for inpatient reimbursement because its higher resource intensity and increased payment weight are driven by the underlying diagnoses, procedure extent, and documented Major Complication or Comorbidity.
DRG 456 Overview
DRG 456 covers inpatient admissions for noncervical spinal fusion procedures performed in the setting of spinal curvature, malignancy, infection, or unusually extensive fusion procedures when a Major Complication or Comorbidity is present. This Diagnosis-Related Group captures high-complexity surgical spine cases with elevated resource use driven by longer operative time, greater implant and implant-related costs, and increased perioperative management needs. It matters for Medicare payment because the presence of a Major Complication or Comorbidity increases the relative weight and payment rate compared with less complex spinal fusion groups. Accurate coding of the underlying diagnoses, procedure extent, and Major Complication or Comorbidity is essential to assigning the correct Diagnosis-Related Group and associated inpatient reimbursement.