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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 853-infectious-and-parasitic-diseases-with-o-r-procedures-with-mcc
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    Infectious and Parasitic Diseases with O.R. Procedures with MCC: Inpatient Reimbursement Overview

    DRG 853 groups inpatient stays for infectious and parasitic diseases requiring operating room procedures plus a Major Complication or Comorbidity; it covers cases with high resource use such as operative source control for severe infections. Correct assignment affects Medicare inpatient reimbursement because operating room procedures and Major Complication or Comorbidity status raise the payment weight for the stay.

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    DRG 853 Overview

    DRG 853 covers hospital admissions for infectious and parasitic diseases that require operating room procedures and include at least one Major Complication or Comorbidity. Typical cases include complex surgical source control or debridement for severe infections, often involving critical care and extended resource use. This grouping matters for Medicare payment because the presence of operating room procedures and a Major Complication or Comorbidity increases relative reimbursement to reflect higher resource intensity. Accurate documentation and coding of procedures and comorbid conditions determine assignment to this Diagnosis-Related Group.

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    National Payment Rates

    Across commercial payers the observed rate range runs from about $43K (BCBS) up to $81K (Cigna), with Anthem and Aetna clustering around $73K–$80K. The widest spread between payer medians is roughly $32K (BCBS median $44K vs. Cigna median $75K). See the table and chart below for full payer percentile detail and distribution.

    The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($44.6k), average submitted covered charges ($216.0k), average Medicare payment amount ($39.0k), and total discharges (82.3k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $45K$220K$39K82K

    Patient Population

    This DRG’s population skews toward Medicare-age beneficiaries, reflecting a higher share of cases coming from the 65+ population rather than predominantly working-age adults. Commercial payers still cover a portion of cases, so the payer mix is mixed but Medicare-dominant. Expect payer distributions to be weighted more heavily to Medicare than to private/commercial coverage.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 853 the observed contracted amounts span from very low floors of $7.5K (Anthem and BCBS) up to $210K (Cigna), with mean benchmarks clustering around $69K–$120K depending on payer. Cigna sits at the top end while Anthem and Blue Cross Blue Shield show the most notable low-end deviation from national medians. See the table and chart below for payer-level percentiles and distribution.

    Key Insights for Alaska

    • Highest-paying payer: Cigna at $120K (p75) / $120K (median) as the top-tier payer among the listed contracts.
    • Lowest-paying payer: Anthem/BCBS at $7.5K (p25) with a very low floor compared with other payers in Alaska.
    • Meaningful deviation: Alaska’s payer spread (from $7.5K to $210K) is wider than typical national medians, driven by Cigna’s and Anthem/BCBS extremes relative to national averages.

    Clinical Trials

    • Acute surgical antimicrobial strategies: randomized or pragmatic trials evaluating perioperative and intraoperative antimicrobial regimens, timing of source-control procedures, and adjunctive sepsis bundles in patients with severe infectious or parasitic diseases who require operative intervention and have major comorbidities (MCC). These studies enroll critically ill inpatients admitted for emergency or planned O.R. procedures for infections such as complicated intra-abdominal sepsis, necrotizing soft tissue infections, or infected prosthetic material, and test endpoints like early organ dysfunction reversal, need for reoperation, and in-hospital mortality. Findings directly inform surgical timing, antibiotic stewardship, and resource use during the highest-cost inpatient phase, which is crucial for clinicians making acute care decisions and for payers managing reimbursement and utilization for DRG 853 admissions.
    • Comparative effectiveness and pathway trials for operative source control techniques: multicenter observational cohorts or randomized studies comparing different O.R. procedures and surgical approaches (for example, open versus minimally invasive source control, staged debridement schedules, or use of negative-pressure therapy) in patients with complex infectious conditions and significant comorbidity burden. These trials focus on functional recovery, complication rates, length of stay, and need for additional surgical interventions among medically complex inpatients who qualify for this DRG. Results help hospitals and payers understand which procedural pathways reduce readmissions, downstream resource use, and costs while maintaining clinical outcomes for high-acuity infectious disease surgical cases.
    • Post-discharge outcomes and care-transition studies: prospective observational studies or interventions assessing post-discharge trajectories, antimicrobial therapy adherence, outpatient parenteral antimicrobial therapy (OPAT) safety, and readmission risk stratification in survivors of O.R.-treated infectious diseases with MCC. These investigations enroll patients discharged after operative management for severe infections to evaluate 30- to 90-day readmissions, complications related to comorbid conditions, and the effectiveness of care coordination programs or telehealth follow-up. Evidence from this area is important for payers and providers seeking to reduce costly readmissions, optimize transitional care pathways, and allocate resources toward post-acute services that improve outcomes for patients in DRG 853.

    Related Codes

    854-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITH-CC

    Infectious and Parasitic Diseases with O.R. Procedures with CC: Inpatient Reimbursement Overview

    855-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

    Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    856-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-MCC

    Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC: Inpatient Reimbursement Overview

    857-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITH-CC

    Postoperative or Post-Traumatic Infections with O.R. Procedures with CC: Inpatient Reimbursement Overview

    858-POSTOPERATIVE-OR-POST-TRAUMATIC-INFECTIONS-WITH-O-R-PROCEDURES-WITHOUT-CC-MCC

    Postoperative or Post-Traumatic Infections with O.R. Procedures without CC/MCC: Inpatient Reimbursement Overview

    862-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITH-MCC

    Postoperative and Post-Traumatic Infections with MCC: Inpatient Reimbursement Overview

    863-POSTOPERATIVE-AND-POST-TRAUMATIC-INFECTIONS-WITHOUT-MCC

    Postoperative and Post-Traumatic Infections without MCC: Inpatient Reimbursement Overview

    864-FEVER-AND-INFLAMMATORY-CONDITIONS

    Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

    865-VIRAL-ILLNESS-WITH-MCC

    Viral Illness with MCC: Inpatient Reimbursement Overview

    866-VIRAL-ILLNESS-WITHOUT-MCC

    Viral Illness without MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 16

    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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    Mean Rates by Payer — National — DRG 853
    Mean Rates by Payer — Alaska — DRG 853