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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 485-knee-procedures-with-principal-diagnosis-of-infection-with-mcc
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    Knee Procedures with Principal Diagnosis of Infection with MCC: Inpatient Reimbursement Overview

    DRG 485 encompasses knee procedures where the principal diagnosis is infection accompanied by a Major Complication or Comorbidity; it covers operative and perioperative care related to infected native knees or prosthetic joint infections. This Diagnosis-Related Group is important for inpatient reimbursement because infection and Major Complication or Comorbidity status increase expected resource consumption and affect Medicare payment classification.

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    DRG 485 Overview

    DRG 485 covers knee procedures performed when the principal diagnosis is an infection with Major Complication or Comorbidity. This category captures cases that typically require operative intervention for infected knee joints or prostheses and often involve intensive medical management. It matters for Medicare payment because the presence of infection and a Major Complication or Comorbidity significantly increases resource use and drives higher Diagnosis-Related Group reimbursement. Accurate clinical documentation of the infection and associated Major Complication or Comorbidity is essential for appropriate assignment to this Diagnosis-Related Group.

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    Clinical Trials

    • Acute surgical management trials: randomized or prospective cohort studies comparing different intraoperative strategies for infected knee procedures, such as debridement and implant retention versus staged exchange arthroplasty, often stratified by presence of multidrug-resistant organisms or biofilm-forming pathogens. These studies enroll hospitalized adults with a principal diagnosis of septic knee joint or periprosthetic joint infection and aim to define which operative approach leads to higher short-term infection control, lower 30–90 day readmission, and reduced need for additional surgeries. Results are directly relevant to surgeons, hospital administrators, and payers because they inform resource-intensive decisions that drive length of stay, operative costs, and early reimbursement outcomes under this DRG.
    • Antimicrobial strategy and optimization studies: comparative effectiveness and pharmacokinetic/pharmacodynamic trials evaluating intravenous antibiotic regimens, duration of therapy, and local antimicrobial delivery (for example, antibiotic-loaded cement spacers) in patients undergoing treatment for knee infections. These trials focus on inpatient and early post-acute populations with confirmed septic arthritis or prosthetic joint infection, assessing clinical cure rates, adverse events, and impacts on hospital resource use such as days of IV therapy versus transition to oral agents. Findings matter to clinicians and payers because antibiotic choice and duration influence inpatient length of stay, complication rates, antimicrobial stewardship metrics, and downstream costs related to readmissions and long-term disability.
    • Post-discharge functional outcomes and care-transition studies: prospective observational cohorts or pragmatic trials examining rehabilitation protocols, outpatient wound care models, and coordinated home health services for patients discharged after infected knee procedures, with endpoints including functional mobility, prosthesis retention, and 90–180 day healthcare utilization. These studies enroll survivors of the acute hospitalization for knee infection—often older adults with comorbidities—and evaluate how different discharge pathways affect recovery, readmission risk, and durable outcomes. Payers and healthcare systems use this evidence to design case management, bundle payments, and post-acute care networks that can reduce costly readmissions and improve long-term functional outcomes for this high-risk DRG population.

    Related Codes

    402-SINGLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL

    Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical: Inpatient Reimbursement Overview

    426-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device: Inpatient Reimbursement Overview

    427-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-CC

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC: Inpatient Reimbursement Overview

    428-MULTIPLE-LEVEL-COMBINED-ANTERIOR-AND-POSTERIOR-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-CC-MCC

    Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC: Inpatient Reimbursement Overview

    429-COMBINED-ANTERIOR-AND-POSTERIOR-CERVICAL-SPINAL-FUSION-WITH-MCC

    Combined Anterior and Posterior Cervical Spinal Fusion with MCC: Inpatient Reimbursement Overview

    430-COMBINED-ANTERIOR-AND-POSTERIOR-CERVICAL-SPINAL-FUSION-WITHOUT-MCC

    Combined Anterior and Posterior Cervical Spinal Fusion without MCC: Inpatient Reimbursement Overview

    447-MULTIPLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Multiple Level Spinal Fusion Except Cervical with MCC: Inpatient Reimbursement Overview

    448-MULTIPLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-MCC

    Multiple Level Spinal Fusion Except Cervical without MCC: Inpatient Reimbursement Overview

    450-SINGLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITH-MCC-OR-CUSTOM-MADE-ANATOMICALLY-DESIGNED-INTERBODY-FUSION-DEVICE

    Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Device: Inpatient Reimbursement Overview

    451-SINGLE-LEVEL-SPINAL-FUSION-EXCEPT-CERVICAL-WITHOUT-MCC

    Single Level Spinal Fusion Except Cervical without 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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