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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 536-fractures-of-hip-and-pelvis-without-mcc
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    Fractures of Hip and Pelvis without MCC: Inpatient Reimbursement Overview

    DRG 536 encompasses inpatient stays for hip and pelvic fractures without Major Complication or Comorbidity, focusing on patients with lower documented clinical complexity. Correct assignment influences Medicare inpatient prospective payment because it determines the payment grouping used for hospital reimbursement.

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    DRG 536 Overview

    DRG 536 covers inpatient admissions for fractures of the hip and pelvis without Major Complication or Comorbidity. This grouping captures patients requiring surgical or nonoperative management whose clinical complexity does not include Major Complication or Comorbidity, making it a common category for orthopedics and trauma services. It matters for Medicare payment because the Diagnosis-Related Group assignment determines the fixed prospective payment amount for the hospital stay under Medicare rules. Accurate clinical coding and documentation directly affect reimbursement classification for these fracture cases.

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    Clinical Trials

    • Acute perioperative intervention trials: randomized or pragmatic studies comparing surgical timing, fixation methods, or anesthesia/analgesia protocols for hospitalized patients with hip or pelvic fractures without major complications. These studies enroll older adults often with frailty or comorbidities who present for urgent operative repair, and they evaluate outcomes such as time to mobilization, in-hospital complications, length of stay, and 30‑day readmission. Results are directly relevant to surgeons, hospitalists, and payers because perioperative approaches drive inpatient resource use, complication rates, and short-term costs under this DRG.
    • Comparative effectiveness studies of rehabilitation and early mobilization strategies initiated during the inpatient stay: observational cohorts or randomized trials comparing different physical therapy intensities, weight-bearing protocols, or coordinated multidisciplinary care pathways for patients recovering from hip or pelvic fracture repair. These trials focus on functional recovery, discharge disposition (home versus skilled nursing), and inpatient-to-postacute transition metrics in older adults with varying baseline mobility, informing which in-hospital rehab approaches most effectively reduce length of stay and downstream institutional care use. Payers and inpatient care teams use this evidence to design care pathways that optimize recovery while controlling utilization tied to the DRG payment.
    • Post-discharge outcomes and secondary prevention research: prospective longitudinal studies evaluating bone health assessment, osteoporosis treatment initiation, fall-prevention programs, and readmission surveillance after discharge for patients treated for hip or pelvic fractures. These studies target survivors of the index hospitalization — often elderly patients at high risk for subsequent fractures and healthcare utilization — measuring rates of secondary fracture, medication adherence, mortality, and long-term functional status. Findings inform inpatient discharge planning, quality metrics, and payer strategies to reduce costly readmissions and future fracture-related admissions associated with this 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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