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    v1.0.28
    OpenPayerBilling CodesPregnancy, Childbirth and the PuerperiumDRG 819-other-antepartum-diagnoses-with-o-r-procedures-without-cc-mcc
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    Other Antepartum Diagnoses with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    DRG 819 encompasses other antepartum diagnoses requiring operating room procedures in the absence of a Major Complication or Comorbidity or a Complication or Comorbidity. It defines the clinical scope for grouping resource use and directly impacts inpatient reimbursement under Medicare payment policies.

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    DRG 819 Overview

    DRG 819 covers antepartum admissions for other maternal diagnoses that involve operating room procedures without a Major Complication or Comorbidity or a Complication or Comorbidity. Typical cases include surgical interventions during pregnancy that are not associated with higher-severity comorbid conditions. This Diagnosis-Related Group affects Medicare payment by grouping resource use and setting the inpatient prospective payment relative to other antepartum groups. Proper assignment influences inpatient reimbursement and hospital case mix reporting.

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    Clinical Trials

    • Trials evaluating perioperative management strategies for antepartum patients undergoing obstetric or related non-obstetric OR procedures, focusing on optimizing timing of surgery, anesthesia approaches, and fetal monitoring protocols. These studies enroll pregnant women in their second or third trimester who require operative interventions for maternal conditions (e.g., cerclage, appendectomy, adnexal surgery) and compare immediate versus delayed interventions or different anesthetic techniques to balance maternal safety and fetal risk. Results inform clinical pathways that can reduce complications, length of stay, and unplanned neonatal or maternal intensive care needs—important for providers optimizing care and for payers interested in cost-effective inpatient management.
    • Comparative effectiveness trials of diagnostic and surgical decision algorithms for antepartum complications that do not meet CC/MCC criteria, such as evaluation of imaging-guided versus clinical observation pathways for suspected adnexal masses or non-severe placental issues. These studies focus on pregnant patients with intermediate-risk presentations to determine which diagnostic-workup or minimally invasive operative choices best prevent escalation to severe morbidity while minimizing unnecessary OR utilization. Findings guide admission criteria, resource allocation, and procedural utilization decisions that affect reimbursement and DRG assignment consistency for hospitals and payers.
    • Prospective cohort or outcomes research examining short-term maternal and neonatal outcomes and readmission rates after OR procedures without CC/MCC in the antepartum period, including patient-reported outcomes and health service utilization up to the postpartum period. These studies follow women discharged after index hospitalization to quantify rates of complications, subsequent obstetric interventions, and neonatal care needs, stratified by procedure type and gestational age at surgery. Evidence from these studies helps providers refine discharge planning and surveillance, and helps payers model post-discharge costs and quality metrics linked to this DRG.

    Related Codes

    768-VAGINAL-DELIVERY-WITH-O-R-PROCEDURES-EXCEPT-STERILIZATION-AND-OR-D-C

    Vaginal Delivery with O.R. Procedures Except Sterilization and/or D&C: Inpatient Reimbursement Overview

    769-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITH-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses with O.R. Procedures: Inpatient Reimbursement Overview

    770-ABORTION-WITH-D-C-ASPIRATION-CURETTAGE-OR-HYSTEROTOMY

    Abortion with D&C, Aspiration Curettage or Hysterotomy: Inpatient Reimbursement Overview

    776-POSTPARTUM-AND-POST-ABORTION-DIAGNOSES-WITHOUT-O-R-PROCEDURES

    Postpartum and Post Abortion Diagnoses without O.R. Procedures: Inpatient Reimbursement Overview

    779-ABORTION-WITHOUT-D-C

    Abortion without D&C: Inpatient Reimbursement Overview

    783-CESAREAN-SECTION-WITH-STERILIZATION-WITH-MCC

    Cesarean Section with Sterilization with MCC: Inpatient Reimbursement Overview

    784-CESAREAN-SECTION-WITH-STERILIZATION-WITH-CC

    Cesarean Section with Sterilization with CC: Inpatient Reimbursement Overview

    785-CESAREAN-SECTION-WITH-STERILIZATION-WITHOUT-CC-MCC

    Cesarean Section with Sterilization without CC/MCC: Inpatient Reimbursement Overview

    786-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-MCC

    Cesarean Section without Sterilization with MCC: Inpatient Reimbursement Overview

    787-CESAREAN-SECTION-WITHOUT-STERILIZATION-WITH-CC

    Cesarean Section without Sterilization with CC: Inpatient Reimbursement Overview

    Showing 1–10 of 22

    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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