Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesDiseases and Disorders of Blood, Blood Forming Organs and Immunologic DisordersDRG 799-splenic-procedures-with-mcc
    Ask Trek AI about this page

    Splenic Procedures with MCC: Inpatient Reimbursement Overview

    DRG 799 encompasses inpatient admissions for splenic procedures performed in the presence of a Major Complication or Comorbidity, representing higher-acuity surgical care. This Diagnosis-Related Group matters because it signals increased resource use and is assigned a higher Medicare payment weight compared with lower-severity splenic procedure groupings.

    Customize your policy alerts

    Sign up for drg 799 policy alerts

    Get alerted when payer policies referencing 799 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    DRG 799 Overview

    DRG 799 covers inpatient admissions involving splenic procedures performed with a documented Major Complication or Comorbidity, typically including splenectomy or other operative interventions for trauma, rupture, hematologic disease, or neoplasm with significant comorbid conditions. This Diagnosis-Related Group groups higher-acuity splenic surgical cases that drive greater resource use, longer lengths of stay, and higher costs, which affects Medicare payment weight and reimbursement. Accurate coding of the principal procedure and the presence of Major Complication or Comorbidity is central to assignment to this Diagnosis-Related Group and subsequent payment determination. The grouping is used by the Centers for Medicare & Medicaid Services to align payment with expected resource consumption for complex splenic cases.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical Trials

    • Acute perioperative management trials: studies evaluating immediate intraoperative and early postoperative strategies for patients undergoing splenic procedures with life-threatening complexity (eg, trauma-related splenectomy or surgery for ruptured splenic lesions) focus on hemostatic techniques, transfusion protocols, and critical care pathways. These trials typically enroll adults with high acuity, multiple organ dysfunction, or massive hemorrhage to test interventions that reduce operative time, blood product use, and early complications. Results inform surgeons, anesthesiologists, and payers by identifying approaches that shorten ICU stays, lower complication-related costs, and improve short-term survival for the highest-resource patients in this DRG.
    • Comparative effectiveness studies of spleen-preserving versus removal strategies in medically complex patients: prospective cohort or randomized studies compare outcomes of splenic repair, partial splenectomy, or embolization against total splenectomy in patients with comorbidities (eg, coagulopathy, chronic liver disease, or immunosuppression) who meet criteria for procedures coded under this DRG. These studies assess morbidity, infection risk, readmission rates, and long-term immune consequences to determine which approach offers best trade-offs for high-risk populations. Findings guide clinical decision-making and payer evaluations by clarifying which procedures reduce downstream resource utilization and long-term costs while maintaining safety in patients with major complications (MCC).
    • Post-discharge outcomes and care coordination research: longitudinal observational studies and pragmatic trials examine transitions of care, vaccination uptake, thromboembolism prophylaxis adherence, and infection surveillance after discharge for patients who had splenic procedures with major complications. These studies enroll survivors discharged from acute care with complex needs (eg, ongoing wound care, immunization needs, or home health) to measure readmissions, outpatient utilization, and quality-of-life outcomes over months to a year. Insights help hospitals and payers design targeted post-acute programs and case management interventions that reduce readmissions and costly complications common in this DRG population.

    Related Codes

    800-SPLENIC-PROCEDURES-WITH-CC

    Splenic Procedures with CC: Inpatient Reimbursement Overview

    801-SPLENIC-PROCEDURES-WITHOUT-CC-MCC

    Splenic Procedures without CC/MCC: Inpatient Reimbursement Overview

    802-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITH-MCC

    Other O.R. Procedures of the Blood and Blood Forming Organs with MCC: Inpatient Reimbursement Overview

    803-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITH-CC

    Other O.R. Procedures of the Blood and Blood Forming Organs with CC: Inpatient Reimbursement Overview

    804-OTHER-O-R-PROCEDURES-OF-THE-BLOOD-AND-BLOOD-FORMING-ORGANS-WITHOUT-CC-MCC

    Other O.R. Procedures of the Blood and Blood Forming Organs without CC/MCC: Inpatient Reimbursement Overview

    808-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITH-MCC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    809-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITH-CC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    810-MAJOR-HEMATOLOGICAL-AND-IMMUNOLOGICAL-DIAGNOSES-EXCEPT-SICKLE-CELL-CRISIS-AND-COAGULATION-DISORDERS-WITHOUT-CC-MCC

    Major Hematological and Immunological Diagnoses: Inpatient Reimbursement Overview

    811-RED-BLOOD-CELL-DISORDERS-WITH-MCC

    Red Blood Cell Disorders with MCC: Inpatient Reimbursement Overview

    812-RED-BLOOD-CELL-DISORDERS-WITHOUT-MCC

    Red Blood Cell Disorders without MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 14

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.