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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Skin, Subcutaneous Tissue and BreastDRG 604-trauma-to-the-skin-subcutaneous-tissue-and-breast-with-mcc
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    Trauma to the Skin, Subcutaneous Tissue and Breast with MCC: Inpatient Reimbursement Overview

    DRG 604 addresses inpatient cases of trauma to the skin, subcutaneous tissue, and breast with a Major Complication or Comorbidity, reflecting higher clinical complexity. This grouping matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases resource intensity and influences Medicare payment rates.

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    DRG 604 Overview

    DRG 604 covers inpatient admissions for trauma to the skin, subcutaneous tissue, and breast when a Major Complication or Comorbidity is present, indicating more severe clinical complexity. These cases often involve extensive wound management, infection control, debridement, reconstructive procedures, or management of systemic complications, which increase resource use. This Diagnosis-Related Group matters for Medicare payment because the presence of a Major Complication or Comorbidity elevates reimbursement relative to less severe groupings to reflect higher expected costs of care. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and therefore affect payment.

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    Clinical Trials

    • Acute surgical intervention trials: randomized or prospective cohort studies comparing different surgical wound management strategies for patients admitted with severe traumatic injuries to the skin, subcutaneous tissue, or breast complicated by major comorbid conditions (eg, diabetes, peripheral vascular disease, immunosuppression). These studies enroll inpatients presenting with complex soft-tissue trauma requiring debridement, closure, or reconstructive procedures, and evaluate outcomes such as infection rates, time to wound closure, need for reoperation, and hospital length of stay. Results inform surgical decision-making and resource use, which directly affect reimbursement, coding accuracy, and inpatient cost management for this high-acuity DRG.
    • Comparative effectiveness research on infection prevention and antibiotic stewardship: pragmatic trials or observational comparative studies assessing perioperative and inpatient antibiotic regimens, topical antiseptics, or negative-pressure wound therapy in patients with traumatic skin and subcutaneous injuries and significant comorbidities that increase infection risk. These studies focus on heterogeneous real-world inpatient populations to determine which prevention strategies reduce surgical site infections, sepsis, and readmissions while minimizing antibiotic overuse. Findings are relevant to clinicians for optimizing care pathways and to payers for reducing costly complications and avoiding extended stays associated with major complication or comorbidity (MCC) classifications.
    • Post-discharge outcomes and recovery studies: longitudinal cohort studies and registries tracking functional recovery, wound healing trajectories, quality of life, and healthcare utilization (eg, readmissions, outpatient visits, home health needs) among survivors of traumatic skin/subcutaneous/breast injuries with MCCs. These studies often stratify by injury severity, comorbidity burden, and index inpatient treatments to identify predictors of long-term disability, need for reconstructive follow-up, and total episode-of-care costs. Understanding post-discharge outcomes helps providers plan discharge resources and care coordination and enables payers to model bundled payments, case management needs, and potential interventions that reduce downstream costs associated with this DRG.

    Related Codes

    570-SKIN-DEBRIDEMENT-WITH-MCC

    Skin Debridement with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    571-SKIN-DEBRIDEMENT-WITH-CC

    Skin Debridement with CC: Inpatient Reimbursement Overview

    572-SKIN-DEBRIDEMENT-WITHOUT-CC-MCC

    Skin Debridement without CC/MCC: Inpatient Reimbursement Overview

    573-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

    Skin Graft for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

    574-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

    Skin Graft for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

    575-SKIN-GRAFT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

    Skin Graft for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

    576-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-MCC

    Skin Graft Except for Skin Ulcer or Cellulitis with MCC: Inpatient Reimbursement Overview

    577-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITH-CC

    Skin Graft Except for Skin Ulcer or Cellulitis with CC: Inpatient Reimbursement Overview

    578-SKIN-GRAFT-EXCEPT-FOR-SKIN-ULCER-OR-CELLULITIS-WITHOUT-CC-MCC

    Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC: Inpatient Reimbursement Overview

    579-OTHER-SKIN-SUBCUTANEOUS-TISSUE-AND-BREAST-PROCEDURES-WITH-MCC

    Other Skin, Subcutaneous Tissue and Breast Procedures with 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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