Summary & Overview
Fractures of Hip and Pelvis with MCC: Inpatient Reimbursement Overview
DRG 535 encompasses fractures of the hip and pelvis with a Major Complication or Comorbidity and represents higher-acuity inpatient cases requiring more resources. This Diagnosis-Related Group matters for inpatient reimbursement because the Major Complication or Comorbidity status increases payment to account for greater clinical complexity and expected resource use under Medicare.
DRG 535 Overview
DRG 535 covers inpatient admissions for fractures of the hip and pelvis when a Major Complication or Comorbidity is present, typically involving older adults with significant injury and medical instability. This Diagnosis-Related Group groups cases with higher resource use due to the need for surgical management, extended acute care, and complex medical management. It matters for Medicare payment because the presence of a Major Complication or Comorbidity increases relative reimbursement to reflect greater expected costs and length of stay. Accurate clinical coding and documentation of Major Complication or Comorbidity are essential to ensure appropriate Medicare Severity Diagnosis-Related Group assignment and payment.