Summary & Overview
Local Excision and Removal of Internal Fixation Devices Except Hip and Femur with MCC: Inpatient Reimbursement Overview
DRG 495 encompasses local excision and removal of internal fixation devices except for hip and femur, when a Major Complication or Comorbidity is present; it covers higher-acuity inpatient orthopedic cases that require more resources. Correct classification matters for inpatient reimbursement because the Major Complication or Comorbidity status influences the Diagnosis-Related Group weight and resultant Medicare payment.
DRG 495 Overview
DRG 495 covers inpatient stays for local excision and removal of internal fixation devices, excluding procedures on the hip and femur, when a Major Complication or Comorbidity is present. Typical cases include removal of plates, screws, rods, or similar orthopedic hardware from extremities or the pelvis (excluding hip and femur) complicated by infection, significant bleeding, or other severe comorbid conditions. This Diagnosis-Related Group is important for Medicare payment because the presence of a Major Complication or Comorbidity increases resource intensity and affects the inpatient reimbursement weight. Accurate coding of the principal procedure and the Major Complication or Comorbidity is therefore central to appropriate Medicare Severity Diagnosis-Related Group assignment and payment.