Infectious and Parasitic Diseases with O.R. Procedures DRG | Reimbursement

Summary & Overview

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.

Infectious and Parasitic Diseases with O.R. Procedures with MCCDRG Infectious and Parasitic Diseases with O.R. Procedures with MCCDRG 853Diagnosis-Related GroupInpatient ReimbursementMedicareSurgeryInfectious DiseaseCritical Care

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.

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.

Mean Rates by Payer — National — DRG 853

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).

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

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: 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

872-SEPTICEMIA-OR-SEVERE-SEPSIS-WITHOUT-MV-96-HOURS-WITHOUT-MCC

Septicemia or Severe Sepsis without MV >96 Hours without MCC: Inpatient Reimbursement Overview

870-SEPTICEMIA-OR-SEVERE-SEPSIS-WITH-MV-96-HOURS

Septicemia or Severe Sepsis with MV >96 Hours: Inpatient Reimbursement Overview

869-OTHER-INFECTIOUS-AND-PARASITIC-DISEASES-DIAGNOSES-WITHOUT-CC-MCC

Other Infectious and Parasitic Diseases Diagnoses without CC/MCC: Inpatient Reimbursement Overview

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

Postoperative and Post-Traumatic Infections without 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

865-VIRAL-ILLNESS-WITH-MCC

Viral Illness with MCC: Inpatient Reimbursement Overview

871-SEPTICEMIA-OR-SEVERE-SEPSIS-WITHOUT-MV-96-HOURS-WITH-MCC

Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

867-OTHER-INFECTIOUS-AND-PARASITIC-DISEASES-DIAGNOSES-WITH-MCC

Other Infectious and Parasitic Diseases Diagnoses with MCC: Inpatient Reimbursement Overview

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Summary & Overview

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

DRG 853 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes