Summary & Overview
Hip Replacement with Principal Diagnosis of Hip Fracture without MCC: Inpatient Reimbursement Overview
DRG 522 applies to inpatient hip replacement for patients with a principal diagnosis of hip fracture without Major Complication or Comorbidity; it defines the clinical population and expected inpatient resource use. This Diagnosis-Related Group is important for inpatient reimbursement because it determines the bundled Medicare payment level and influences documentation and coding that affect hospital payment.
DRG 522 Overview
DRG 522 covers inpatient admissions for hip replacement when the principal diagnosis is a hip fracture and there is no Major Complication or Comorbidity present. This Diagnosis-Related Group captures cases where surgical repair or replacement of the hip is performed for fracture without the added resource intensity of major comorbid conditions. It matters for Medicare payment because the Diagnosis-Related Group assignment drives the bundled prospective payment for the inpatient stay. Accurate coding of the principal diagnosis and secondary conditions determines whether this Diagnosis-Related Group, a lower-paying fracture replacement category, is assigned instead of higher-paying groups with complication indicators.