Infectious and Parasitic Diseases DRG 854 Reimbursement

Summary & Overview

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

DRG 854 includes inpatient stays for infectious and parasitic diseases requiring operating room procedures with a Complication or Comorbidity; it encompasses surgical management of serious infections. This Diagnosis-Related Group matters because the combination of operative care and documented Complication or Comorbidity increases inpatient resource use and thus affects Medicare payment.

Infectious and Parasitic Diseases with O.R. Procedures with CCDRG Infectious and Parasitic Diseases with O.R. Procedures with CCDRG 854Diagnosis-Related GroupInpatient ReimbursementMedicareSurgeryInfectious DiseaseSepsisOperative Management

DRG 854 Overview

DRG 854 covers hospital admissions for infectious and parasitic diseases that require operating room procedures and have at least a Complication or Comorbidity. Conditions in this group span serious infections needing surgical intervention, such as debridement, drainage, or other operative management for sepsis-related sources or localized infectious processes. This Diagnosis-Related Group matters for Medicare payment because the presence of an operating room procedure plus a Complication or Comorbidity influences the relative resource intensity and payment weight for inpatient reimbursement. Accurate clinical documentation and coding determine assignment to this Diagnosis-Related Group and the corresponding Medicare Severity Diagnosis-Related Group payment impact.

National Payment Rates

Across commercial payers the observed rate range runs from about $370 to $82K, with payer medians clustered between roughly $20K and $36K; the widest spread is seen between the lowest value ($370) and highest value ($82K) as shown in the table and chart below. Blue Cross Blue Shield, Aetna, Cigna, and Anthem exhibit differing median levels, with commercial benchmarks generally above Medicare averages. Refer to the table and chart for payer-specific quartiles and distributions.

Mean Rates by Payer — National — DRG 854

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska rates for DRG 854 range broadly across payers, from Anthem's low-end observations (min $7.5K, mean $29K, median $31K) up to Cigna’s substantially higher values (median $48K, mean $50K, max $85K). The most notable deviation from national averages is Cigna’s elevated mean and median in Alaska, which sit well above national medians for major payers. See the table and chart below for payer-level distributions.

Key Insights for Alaska

Highest payer: Cigna (median $48K, mean $50K) and lowest payer: Anthem (median $31K, mean $29K) among listed payers in Alaska.
Alaska's payer range spans from about $7.5K (Anthem min) up to $85K (Cigna max); Cigna's mean and median sit meaningfully above national medians for major payers, indicating higher reimbursements in-state for DRG 854.
Blue Cross Blue Shield in Alaska shows a median near Anthem ($31K) but a higher 75th percentile ($36K) compared with national BCBS median, suggesting slightly elevated upper-end rates locally.

Clinical Trials

Acute surgical management and perioperative infection control studies: randomized or pragmatic trials evaluating operative timing, prophylactic antimicrobial regimens, and intraoperative infection prevention bundles for patients undergoing operative procedures for severe infectious and parasitic diseases (for example, source-control surgeries for intra-abdominal sepsis or debridement for necrotizing soft-tissue infection). These studies typically enroll hospitalized adults who require O.R. procedures and have one or more complicating comorbidities (the CC component), and they measure outcomes such as postoperative infectious complication rates, need for reoperation, length of stay, and ICU utilization. Results inform best practices that reduce acute morbidity, resource use, and complications that drive DRG payments and downstream costs for providers and payers.
Comparative effectiveness trials of antimicrobial strategies and adjunctive therapies in complex infectious presentations: head-to-head or pragmatic studies comparing different systemic antimicrobial approaches (duration, route-switch strategies, narrow- versus broad-spectrum stewardship strategies) or adjunctive interventions (e.g., source-control timing, negative-pressure wound therapy, or immunomodulatory support) in patients with operative management for infectious/parasitic disease and coexisting comorbidities. These studies enroll heterogeneous inpatient populations representative of real-world complexity under DRG 854 and focus on clinical cure, recurrence, antimicrobial resistance emergence, and healthcare resource utilization. Findings guide formulary decisions, antibiotic stewardship policies, and clinical pathways that impact readmissions, antibiotic costs, and overall reimbursement risk for hospitals and payers.
Post-discharge outcomes, readmission prevention, and care-transition research: observational cohorts and interventional trials testing enhanced discharge planning, outpatient parenteral antimicrobial therapy (OPAT) models, telehealth follow-up, and home-care coordination specifically for patients who had O.R. procedures for infectious conditions with complicating comorbidities. These studies target the high-risk early post-discharge period to reduce readmissions, catheter-related complications, and outpatient adverse events, enrolling patients discharged after operative management and tracking 30- to 90-day outcomes, quality-of-life, and total cost of care. Evidence from these studies is highly relevant to providers and payers because reducing avoidable readmissions and post-acute complications directly affects DRG-related performance metrics, bundled-payment performance, and overall expenditures.

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

864-FEVER-AND-INFLAMMATORY-CONDITIONS

Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

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

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

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

Other Infectious and Parasitic Diseases Diagnoses 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

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

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

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: Inpatient Reimbursement Overview

Showing 1–10 of 16

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$19K	$93K	$15K	21K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 854

Key Insights for Alaska

Highest payer: Cigna (median $48K, mean $50K) and lowest payer: Anthem (median $31K, mean $29K) among listed payers in Alaska.
Alaska's payer range spans from about $7.5K (Anthem min) up to $85K (Cigna max); Cigna's mean and median sit meaningfully above national medians for major payers, indicating higher reimbursements in-state for DRG 854.
Blue Cross Blue Shield in Alaska shows a median near Anthem ($31K) but a higher 75th percentile ($36K) compared with national BCBS median, suggesting slightly elevated upper-end rates locally.

Clinical Trials

Acute surgical management and perioperative infection control studies: randomized or pragmatic trials evaluating operative timing, prophylactic antimicrobial regimens, and intraoperative infection prevention bundles for patients undergoing operative procedures for severe infectious and parasitic diseases (for example, source-control surgeries for intra-abdominal sepsis or debridement for necrotizing soft-tissue infection). These studies typically enroll hospitalized adults who require O.R. procedures and have one or more complicating comorbidities (the CC component), and they measure outcomes such as postoperative infectious complication rates, need for reoperation, length of stay, and ICU utilization. Results inform best practices that reduce acute morbidity, resource use, and complications that drive DRG payments and downstream costs for providers and payers.
Comparative effectiveness trials of antimicrobial strategies and adjunctive therapies in complex infectious presentations: head-to-head or pragmatic studies comparing different systemic antimicrobial approaches (duration, route-switch strategies, narrow- versus broad-spectrum stewardship strategies) or adjunctive interventions (e.g., source-control timing, negative-pressure wound therapy, or immunomodulatory support) in patients with operative management for infectious/parasitic disease and coexisting comorbidities. These studies enroll heterogeneous inpatient populations representative of real-world complexity under DRG 854 and focus on clinical cure, recurrence, antimicrobial resistance emergence, and healthcare resource utilization. Findings guide formulary decisions, antibiotic stewardship policies, and clinical pathways that impact readmissions, antibiotic costs, and overall reimbursement risk for hospitals and payers.
Post-discharge outcomes, readmission prevention, and care-transition research: observational cohorts and interventional trials testing enhanced discharge planning, outpatient parenteral antimicrobial therapy (OPAT) models, telehealth follow-up, and home-care coordination specifically for patients who had O.R. procedures for infectious conditions with complicating comorbidities. These studies target the high-risk early post-discharge period to reduce readmissions, catheter-related complications, and outpatient adverse events, enrolling patients discharged after operative management and tracking 30- to 90-day outcomes, quality-of-life, and total cost of care. Evidence from these studies is highly relevant to providers and payers because reducing avoidable readmissions and post-acute complications directly affects DRG-related performance metrics, bundled-payment performance, and overall expenditures.

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

864-FEVER-AND-INFLAMMATORY-CONDITIONS

Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

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

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

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

Other Infectious and Parasitic Diseases Diagnoses 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

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

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

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: Inpatient Reimbursement Overview

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OpenPayer

Summary & Overview

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

DRG 854 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