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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Musculoskeletal System and Connective TissueDRG 550-septic-arthritis-without-cc-mcc
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    Septic Arthritis without CC/MCC: Inpatient Reimbursement Overview

    DRG 550 addresses septic arthritis cases without Complication or Comorbidity or Major Complication or Comorbidity, focusing on infections confined to joints that require inpatient management. Understanding this Diagnosis-Related Group is important for hospitals because it defines the Medicare inpatient reimbursement level for relatively lower-resource septic arthritis admissions.

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    DRG 550 Overview

    DRG 550 covers inpatient admissions for septic arthritis without a Complication or Comorbidity or Major Complication or Comorbidity, typically involving single-joint bacterial infection requiring surgical drainage or intravenous antibiotic therapy. This Diagnosis-Related Group groups cases with lower resource use than complicated septic arthritis, making it a distinct payment category under Medicare inpatient reimbursement. It matters because assignment to this Diagnosis-Related Group determines bundled payment amounts that hospitals receive for the episode of care. Accurate clinical documentation and coding are essential to ensure appropriate payment classification.

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    Clinical Trials

    • Acute antimicrobial optimization trials: randomized or adaptive studies testing different antibiotic strategies (e.g., duration, route switching from IV to oral, or narrow- versus broad-spectrum agents) in adults hospitalized with septic arthritis without major comorbid complications. These studies enroll patients presenting with bacterial joint infection requiring inpatient drainage and initial parenteral therapy, and they focus on time to clinical resolution, need for repeat surgical drainage, and adverse events related to antibiotics. Results are directly relevant to hospital clinicians and payers because optimized regimens can shorten length of stay, reduce inpatient medication costs, and lower readmission risk while maintaining safety.
    • Procedural and perioperative comparative effectiveness research: prospective cohort studies or pragmatic randomized trials comparing approaches to source control (arthroscopic versus open surgical drainage, single versus staged procedures, or use of image-guided aspiration) and standardized peri-procedural care bundles in adults with septic arthritis. These studies target the acute-care population requiring joint drainage, evaluating outcomes such as need for repeat intervention, functional joint recovery, complication rates, and inpatient resource utilization. Findings inform surgical decision-making and reimbursement policy by identifying procedures and care pathways that minimize complications and downstream costs for patients classified in this DRG.
    • Post-discharge outcomes and care-transition studies: observational and intervention studies examining outpatient follow-up models, home infusion versus early oral transition, physical therapy initiation timing, and monitoring strategies to prevent relapse or long-term disability after hospital discharge for septic arthritis without CC/MCC. These investigations enroll patients discharged after initial infection control, tracking readmissions, functional outcomes, adherence to therapy, and total episode-of-care costs over 30–90 days. Evidence from this area helps payers and providers design discharge planning and post-acute services that reduce readmissions and optimize recovery while controlling post-discharge spending.

    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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