Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • 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.

    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of Blood, Blood Forming Organs and Immunologic DisordersDRG 813-coagulation-disorders
    Ask Trek AI about this page

    Coagulation Disorders: Inpatient Reimbursement Overview

    DRG 813 covers inpatient admissions for coagulation and bleeding disorders, including anticoagulant-related complications and thrombocytopenia, and affects how Medicare classifies resource use for payment. Correct coding of principal and secondary diagnoses matters because it determines Diagnosis-Related Group assignment, which in turn influences inpatient reimbursement and case-mix reporting.

    Customize your policy alerts

    Sign up for drg 813 policy alerts

    Get alerted when payer policies referencing 813 are released or updated.

    Monitor payer policy activity

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

    DRG 813 Overview

    DRG 813 Coagulation Disorders captures hospitalizations primarily for disorders of hemostasis and coagulation, including bleeding diatheses, thrombocytopenias, and anticoagulant-related complications. This Diagnosis-Related Group matters for Medicare payment because it groups cases with similar clinical resource needs and influences inpatient payment assignments and case-mix. Accurate principal and secondary diagnosis coding drives correct DRG assignment and impacts reimbursement and quality measurement. Hospitals often see variability in resource use due to transfusions, procedures to control bleeding, and management of underlying etiologies.

    Table of contents

    Progress1 / 3

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • 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 hemostatic intervention trials: randomized or single-arm studies evaluating the efficacy and safety of immediate hemostatic strategies (for example, factor replacement dosing regimens, reversal agents for anticoagulation, or blood product protocols) in hospitalized patients presenting with active bleeding or severe coagulopathy. These studies focus on inpatients often in the emergency department, ICU, or perioperative setting who have acute bleeding related to congenital or acquired coagulation disorders, anticoagulant therapy, liver disease, or disseminated intravascular coagulation. Results are directly relevant to clinicians deciding rapid management pathways and to payers because they affect transfusion utilization, ICU length of stay, and short-term costs associated with bleeding complications.
    • Comparative effectiveness and dosing optimization studies: head-to-head or pragmatic trials comparing different maintenance strategies for preventing bleeding events in patients with chronic coagulation disorders (such as prophylactic versus on-demand factor replacement, alternative dosing schedules, or different formulations). These trials enroll outpatients with recurrent bleeding risk or recently discharged patients transitioning to maintenance therapy, and measure outcomes including breakthrough bleeding rates, hospital readmissions, infusion-related adverse events, and resource use. Payers and providers benefit from evidence on which long-term regimens reduce hospitalization and downstream costs while maintaining safety and quality of life for patients in this DRG.
    • Post-discharge outcomes and care-pathway implementation studies: observational cohorts or quality-improvement trials assessing multidisciplinary discharge strategies, patient education, adherence monitoring, and outpatient follow-up models to reduce readmissions and complications among patients hospitalized for coagulation disorders. Populations include survivors of severe bleeding episodes, patients newly started on anticoagulation reversal protocols, and those with complex comorbidities like liver disease who require coordinated care. This research identifies system-level interventions that influence 30‑ and 90‑day readmission rates, outpatient utilization, and total cost of care—key metrics for hospitals and insurers managing DRG-based reimbursement.

    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

    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.