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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 486-knee-procedures-with-principal-diagnosis-of-infection-with-cc
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    Knee Procedures with Principal Diagnosis of Infection with CC: Inpatient Reimbursement Overview

    DRG 486 includes inpatient knee procedures where the principal diagnosis is infection with a Complication or Comorbidity; it encompasses surgical management of infected knees with added clinical complexity. Accurate coding and documentation matter for inpatient reimbursement because the Diagnosis-Related Group determines the fixed Medicare payment reflecting the increased resource use of infected knee cases with Complication or Comorbidity.

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    DRG 486 Overview

    DRG 486 covers knee procedures performed with a principal diagnosis of infection accompanied by a Complication or Comorbidity. This grouping captures inpatient stays where surgical management of an infected knee is required and additional clinical complexity increases resource use. It matters for Medicare payment because the Diagnosis-Related Group assignment drives the prospective fixed payment for the hospital stay, reflecting higher expected costs when infection plus Complication or Comorbidity are present. Appropriate coding of the infection and associated comorbid conditions determines assignment to this Diagnosis-Related Group and the associated reimbursement level.

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    Clinical Trials

    • Acute surgical and perioperative management trials: randomized or prospective studies evaluating timing and extent of surgical intervention (e.g., immediate debridement with implant retention versus staged explant and reimplant) and standardized perioperative care bundles for patients admitted with prosthetic or native knee joint infection. These studies enroll patients at presentation to inpatient services with confirmed knee infection and compare short-term outcomes such as infection eradication, need for repeat operations, length of stay, and perioperative complications; they are relevant because surgical strategy and timing drive resource utilization, device use, and acute inpatient costs for this DRG.
    • Comparative effectiveness studies of antibiotic regimens and delivery strategies in the inpatient setting: pragmatic trials or observational comparative-effectiveness research comparing intravenous antibiotic strategies, duration of inpatient IV therapy versus early step-down to outpatient parenteral or oral regimens, and use of local antibiotic carriers in conjunction with surgery. These studies focus on adults hospitalized with septic arthritis or prosthetic joint infection of the knee, often stratified by organism and presence of comorbidities, and are important to providers and payers because antimicrobial strategy impacts length of stay, readmission risk, antimicrobial resistance risk, and overall treatment costs for patients classified under this DRG.
    • Post-discharge functional and health-economic outcomes research: cohort studies or randomized trials assessing rehabilitation timing, structured physical therapy programs, patient-reported outcomes, and readmission prevention interventions after hospital discharge following knee infection treatment. These investigations enroll survivors of inpatient treatment (including those with staged arthroplasty or knee fusion) to measure longer-term mobility, quality of life, prosthesis survival, and total cost of care over months to years; results inform care pathways, allocation of post-acute resources, and reimbursement strategies aimed at reducing downstream costs and improving value for this high-risk DRG.

    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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