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    OpenPayerBilling CodesEndocrine, Nutritional and Metabolic Diseases and DisordersDRG 616-amputation-of-lower-limb-for-endocrine-nutritional-and-metabolic-disorders-with-mcc
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    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

    DRG 616 addresses inpatient admissions for lower limb amputation associated with endocrine, nutritional, and metabolic disorders when a Major Complication or Comorbidity is present, encompassing cases such as amputation for advanced diabetic complications. Correct classification matters for inpatient reimbursement because the Major Complication or Comorbidity status increases resource intensity and influences Medicare payment.

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    DRG 616 Overview

    DRG 616 covers inpatient hospital admissions for lower limb amputation procedures performed in the setting of underlying endocrine, nutritional, and metabolic disorders when a Major Complication or Comorbidity is present. Typical cases include amputations related to advanced diabetic foot disease, severe peripheral vascular compromise, or metabolic complications that increase clinical complexity. This Diagnosis-Related Group is important for Medicare payment because the presence of a Major Complication or Comorbidity increases relative resource use and affects the hospital reimbursement weight. Hospitals and coders must accurately document operative procedures and the qualifying comorbid conditions to align clinical care with appropriate Medicare Severity Diagnosis-Related Group assignment.

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    Clinical Trials

    • Acute perioperative studies evaluating strategies to reduce surgical site infection, stump healing complications, and immediate postoperative mortality in patients undergoing lower limb amputation for diabetic or metabolic limb ischemia. These trials enroll high-risk inpatients with severe peripheral arterial disease, diabetic foot infection, or critical limb ischemia undergoing major amputation and compare interventions such as optimized perioperative glycemic control protocols, antibiotic regimens, or wound care bundles. Results are directly relevant to hospital providers and payers because reducing early complications shortens length of stay, lowers readmission risk, and decreases high-cost resource utilization tied to this DRG.
    • Comparative effectiveness studies examining different levels of amputation and limb-sparing versus amputation approaches in patients with endocrine, nutritional or metabolic disease–related limb loss. These observational cohorts or pragmatic randomized studies focus on functional outcomes, prosthetic suitability, complication rates, and long-term survival among patients with diabetes, renal disease, or peripheral neuropathy to determine which surgical choice yields better mobility and lower overall costs. Findings inform surgical decision-making, discharge planning, and payer coverage policies by linking index procedure choice to downstream rehabilitation needs, prosthesis costs, and recurrent hospitalization rates.
    • Post-discharge longitudinal outcomes and care-coordination trials aimed at reducing readmissions and improving rehabilitation and prosthetic access for survivors of major lower limb amputation due to metabolic disease. These studies test case-management models, home-based wound surveillance, telehealth follow-up, and integrated vascular/diabetes clinics in the months after discharge for patients with multiple comorbidities and high social needs. For providers and payers, evidence from these trials supports interventions that improve functional recovery and quality of life while potentially lowering readmission and long-term care costs associated with this DRG.

    Related Codes

    614-ADRENAL-AND-PITUITARY-PROCEDURES-WITH-CC-MCC

    Adrenal and Pituitary Procedures with CC/MCC: Inpatient Reimbursement Overview

    615-ADRENAL-AND-PITUITARY-PROCEDURES-WITHOUT-CC-MCC

    Adrenal and Pituitary Procedures without CC/MCC: Inpatient Reimbursement Overview

    617-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

    618-AMPUTATION-OF-LOWER-LIMB-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

    Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: Inpatient Reimbursement Overview

    619-O-R-PROCEDURES-FOR-OBESITY-WITH-MCC

    O.R. Procedures for Obesity with MCC: Inpatient Reimbursement Overview

    620-O-R-PROCEDURES-FOR-OBESITY-WITH-CC

    O.R. Procedures for Obesity with CC: Inpatient Reimbursement Overview

    621-O-R-PROCEDURES-FOR-OBESITY-WITHOUT-CC-MCC

    O.R. Procedures for Obesity without CC/MCC: Inpatient Reimbursement Overview

    622-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-MCC

    Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: Inpatient Reimbursement Overview

    623-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITH-CC

    Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: Inpatient Reimbursement Overview

    624-SKIN-GRAFTS-AND-WOUND-DEBRIDEMENT-FOR-ENDOCRINE-NUTRITIONAL-AND-METABOLIC-DISORDERS-WITHOUT-CC-MCC

    Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/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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