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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 545-connective-tissue-disorders-with-mcc
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    Connective Tissue Disorders with MCC: Inpatient Reimbursement Overview

    DRG 545 encompasses inpatient hospitalizations for connective tissue disorders with a Major Complication or Comorbidity and represents higher-acuity, higher-cost cases. This category matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases the Diagnosis-Related Group weight and therefore the Medicare payment for the episode of care.

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    DRG 545 Overview

    DRG 545 covers inpatient stays for connective tissue disorders when a Major Complication or Comorbidity is present, typically including severe systemic inflammatory conditions, severe autoimmune manifestations, and complications such as sepsis or organ dysfunction related to the underlying disease. This Diagnosis-Related Group groups cases with higher resource use and clinical complexity, which affects Medicare payment through higher relative weights and reimbursement levels compared with cases without a Major Complication or Comorbidity. Accurate reporting of principal diagnosis, secondary diagnoses, and procedures drives correct assignment to this Diagnosis-Related Group and corresponding payment. Coding specificity for severity and documented complications is central to classifying these hospitalizations.

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    Clinical Trials

    • Acute immunomodulatory intervention trials: Studies testing short-term inpatient interventions (for example, high-dose corticosteroid protocols, plasma exchange, or IV immunoglobulin regimens) for patients admitted with severe, life-threatening flares or complications of connective tissue disorders and a major complication or comorbidity (MCC) such as organ failure, diffuse alveolar hemorrhage, or severe infection. These trials enroll hospitalized adults with acute presentations that require immediate escalation of care; they measure time to stabilization, duration of intensive care, and in-hospital morbidity and mortality. Results inform hospital clinical pathways and resource allocation decisions for high-cost, high-acuity admissions under this DRG.
    • Comparative effectiveness studies of inpatient management strategies: Head-to-head evaluations compare different inpatient care approaches (for example, early aggressive immunosuppression versus stepwise escalation, multidisciplinary team models versus standard care, or different venous thromboembolism prophylaxis strategies) in patients with connective tissue diseases complicated by serious comorbid conditions like sepsis, renal failure, or thrombotic events. These studies typically include heterogeneous hospitalized populations stratified by severity and comorbidity burden and assess outcomes such as length of stay, complication rates, readmission risk, and short-term functional status. Findings are directly relevant to providers and payers because they can identify care patterns that reduce complications and costs while maintaining quality for complex DRG 545 admissions.
    • Post-discharge outcomes and transitional care trials: Research focused on interventions initiated during the hospital stay to improve post-discharge outcomes—such as structured discharge planning, early outpatient specialty follow-up, home-based monitoring, or medication reconciliation programs—for patients hospitalized with connective tissue disorders and MCCs. These studies enroll patients at discharge or shortly after and measure 30- to 90-day readmissions, emergency visits, medication adherence, and disease-specific relapse rates. Demonstrating reduced readmissions and better outpatient disease control is important to payers and health systems aiming to manage total episode costs and improve long-term outcomes for this high-risk DRG population.

    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

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    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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