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    OpenPayerBilling CodesDiseases and Disorders of Blood, Blood Forming Organs and Immunologic DisordersDRG 812-red-blood-cell-disorders-without-mcc
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    Red Blood Cell Disorders without MCC: Inpatient Reimbursement Overview

    DRG 812 encompasses inpatient stays for red blood cell disorders without a Major Complication or Comorbidity, including uncomplicated anemias and related hematologic conditions. Accurate grouping matters because it determines Medicare inpatient prospective payment system reimbursement levels tied to expected resource use.

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    DRG 812 Overview

    DRG 812 covers inpatient admissions for red blood cell disorders without a Major Complication or Comorbidity and typically includes diagnoses such as uncomplicated anemia, certain hemolytic anemias, and postoperative or drug-induced red blood cell abnormalities. This Diagnosis-Related Group groups cases with similar resource use for purposes of Medicare payment and affects base payment rates and inpatient prospective payment system adjustments. Hospitals and coders must accurately assign principal and secondary diagnoses to ensure correct grouping. The classification influences reimbursement by reflecting expected resource consumption for these medical hematologic conditions.

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    Clinical Trials

    • Acute transfusion strategy trials: studies comparing restrictive versus liberal red blood cell transfusion thresholds in hospitalized patients with anemia from non-surgical causes (eg, iron-deficiency anemia, hemolytic disorders, anemia of chronic disease) to determine short-term outcomes such as hemodynamic stability, oxygenation, and length of stay. These trials typically enroll adult inpatients who meet specific hemoglobin cutoffs and assess immediate clinical responses and transfusion-related adverse events, informing safe transfusion practices. Results are directly relevant to hospital clinicians and payers because transfusion frequency and timing are major drivers of resource use, costs, and inpatient complications within this DRG.
    • Comparative effectiveness studies of etiologic-specific medical management: pragmatic trials or observational comparative studies evaluating different non-transfusion therapies (for example, iron supplementation routes, erythropoiesis-stimulating strategies, or immunomodulatory regimens) for discrete red blood cell disorders without major complications. These studies focus on defined subgroups such as patients with iron-deficiency anemia, autoimmune hemolytic anemia, or anemia of chronic kidney disease who are admitted for symptomatic anemia but lack major comorbid complications; outcomes include need for subsequent transfusion, readmission, functional status at discharge, and hospital resource utilization. Findings help providers choose treatments that reduce inpatient interventions and help payers predict and manage utilization patterns and coverage decisions for therapies used during the index hospitalization.
    • Post-discharge outcomes and care-transition research: cohort studies and interventional trials testing discharge planning, outpatient monitoring, and outpatient therapy initiation (eg, scheduled iron infusions, follow-up for hemoglobin targets, or adherence supports) to prevent readmissions and continued anemia-related morbidity. These studies enroll patients discharged after an admission for red blood cell disorders without major complications, measuring 30- and 90-day readmission rates, outpatient treatment uptake, and patient-reported outcomes. For hospitals and payers, this research identifies effective strategies to lower readmission penalties, reduce downstream costs, and improve longer-term quality metrics associated with this DRG.

    Related Codes

    799-SPLENIC-PROCEDURES-WITH-MCC

    Splenic Procedures with MCC: Inpatient Reimbursement Overview

    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

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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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