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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 535-fractures-of-hip-and-pelvis-with-mcc
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    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.

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    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.

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    Clinical Trials

    • Acute surgical timing and fixation method trials: randomized or prospective studies comparing early (within 24–48 hours) versus delayed surgical repair and different fixation strategies (e.g., internal fixation configurations or hemiarthroplasty versus fixation) for elderly patients with displaced hip fractures and pelvic ring injuries complicated by major comorbidities. These trials focus on perioperative outcomes such as in-hospital mortality, complication rates (e.g., deep infection, thromboembolism), transfusion needs, and length of stay, addressing the immediate management decisions that drive inpatient resource use. Results inform hospital protocols and payer decisions about perioperative pathways that can reduce costly complications and shorten acute stays for this high-risk DRG population.
    • Comparative effectiveness and risk-stratified care pathway studies: observational cohorts or pragmatic trials that evaluate multimodal geriatric co-management, orthogeriatric models, and risk-adjusted protocols (including optimization of medical comorbidities, delirium prevention, anticoagulation management, and standardized DVT prophylaxis) versus usual orthopedic care in frail older adults with hip and pelvic fractures with major complications. These studies enroll typical DRG 535 patients who are older, have multiple chronic conditions and MCCs, and often present with polypharmacy; they measure outcomes such as inpatient complications, readmission rates, functional recovery at discharge, and total episode costs. Findings are relevant to providers and payers because they identify care models that can lower complication-driven reimbursements, reduce length of stay, and improve discharge disposition for a high-cost inpatient cohort.
    • Post-discharge functional outcomes and secondary prevention studies: prospective longitudinal studies and program evaluations assessing rehab intensity, transitional care interventions, bone health evaluation (osteoporosis management), and fall-prevention strategies after hospitalization for hip or pelvic fracture with major complications. These studies follow patients after discharge to measure 30- to 365-day readmissions, long-term mobility and independence, secondary fracture rates, and downstream utilization of skilled nursing or institutional care. For hospitals and payers, evidence from these studies guides investments in post-acute services and secondary prevention that can decrease costly readmissions and long-term institutionalization in this vulnerable DRG group.

    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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