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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 548-septic-arthritis-with-mcc
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    Septic Arthritis with MCC: Inpatient Reimbursement Overview

    DRG 548 pertains to septic arthritis cases with a Major Complication or Comorbidity, reflecting higher clinical severity and resource needs. This grouping matters for inpatient reimbursement because the Major Complication or Comorbidity designation increases the Diagnosis-Related Group payment relative to less severe classifications.

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    DRG 548 Overview

    DRG 548 covers inpatient admissions for septic arthritis accompanied by a Major Complication or Comorbidity. This Diagnosis-Related Group captures cases with higher resource use due to severe infection, systemic involvement, or significant comorbid conditions that complicate care. It matters for Medicare payment because the presence of a Major Complication or Comorbidity elevates the relative weight and reimbursement compared with lower-severity groupings. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and influence inpatient payment.

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    Clinical Trials

    • Trials of early diagnostic and rapid pathogen identification strategies in acute septic arthritis with life-threatening complications (MCC). These studies evaluate rapid synovial fluid molecular diagnostics, blood-based biomarkers, and point-of-care ultrasound-guided aspiration protocols in adult inpatients who present with systemic sepsis or severe comorbidity-driven presentations (for example immunosuppression, diabetes, prosthetic joints). Rapid, accurate diagnosis is relevant to providers for timely source control and appropriate antimicrobial selection, and to payers because faster diagnosis can shorten ICU stays, reduce broad-spectrum antibiotic use, and lower overall hospitalization costs.
    • Comparative effectiveness studies of surgical versus percutaneous management approaches for septic arthritis complicated by major comorbid conditions. These randomized or pragmatic cohort studies enroll patients with septic arthritis complicated by MCC (such as concurrent bacteremia, organ failure, or prosthetic joint involvement) to compare outcomes of open arthrotomy, arthroscopic washout, and image-guided drainage in terms of joint preservation, infection clearance, length of stay, and readmission. Findings inform clinical pathways and resource utilization decisions for providers, and help payers evaluate which interventions deliver better outcomes per cost in a high-acuity DRG population.
    • Post-discharge outcomes and care-transition research focusing on functional recovery, readmission prevention, and antimicrobial stewardship after hospitalization for septic arthritis with MCC. These observational or interventional studies follow high-risk inpatients after discharge to test structured outpatient parenteral antibiotic therapy programs, rehabilitation intensity, and monitoring protocols for recurrent infection or complications in patients with comorbidities like renal failure or prosthetic joints. Results are important to providers for planning discharge and outpatient follow-up, and to payers because improved transitions and targeted stewardship can reduce costly readmissions and long-term disability associated with this complex 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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