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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 856-postoperative-or-post-traumatic-infections-with-o-r-procedures-with-mcc
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    Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC: Inpatient Reimbursement Overview

    DRG 856 encompasses postoperative or post-traumatic infections requiring operating room procedures and presence of a Major Complication or Comorbidity, reflecting complex surgical and medical needs. This matters for inpatient reimbursement because the higher clinical severity and operative resource use drive elevated Medicare payment relative to lower-severity infection Diagnosis-Related Groups.

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    DRG 856 Overview

    DRG 856 covers inpatient admissions for postoperative or post-traumatic infections that require an operating room procedure and are complicated by a Major Complication or Comorbidity. Typical cases include deep surgical site infections, infected hardware removals, or necrotizing soft tissue infections requiring operative debridement. This Diagnosis-Related Group is high-cost due to operative intervention, extended antimicrobial therapy, and intensive postoperative care needs. It is important for Medicare payment because the presence of a Major Complication or Comorbidity elevates reimbursement relative to less-complex infection groups.

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    National Payment Rates

    Across commercial payers the observed negotiated rates span from roughly $370 to $160K, with payer means ranging from $39K (Blue Cross Blue Shield) to $74K (Cigna and Aetna). The widest spread is seen between the minimum and maximum values across payers (about $160K). See the table and chart below for payer-level detail and percentile breakdowns.

    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 presents average total payment ($41.6k), average submitted covered charges ($189.1k), average Medicare payment ($35.4k), and total discharges (7.3k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $42K$190K$35K7.3K

    Patient Population

    This DRG population typically includes a mix of Medicare and commercial enrollees, but volume often skews toward Medicare-age patients given the higher hospitalization rates in older adults. Commercial (working-age) patients are also represented, resulting in a mixed-age cohort. Payer mix therefore commonly reflects a substantial Medicare share alongside private/commercial coverage.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Across payers in Alaska for DRG 856, negotiated means range from $71K (Blue Cross Blue Shield) to $110K (Cigna), with Anthem matching BCBS at $71K. Cigna shows the widest spread in the state (min $59K to max $180K) and a mean that meaningfully exceeds typical national medians for this DRG. See the table and chart below for payer-level detail.

    Key Insights for Alaska

    • Highest payer: Cigna at $110K (range up to $180K); Lowest payer: Blue Cross Blue Shield at $71K.
    • Alaska’s mean rates skew higher than national medians for this DRG, with Cigna notably above the national Cigna mean and BCBS fixed at a lower, flat $71K.

    Clinical Trials

    • Acute surgical intervention and antimicrobial strategy trials: randomized or prospective cohort studies comparing operative approaches (e.g., timing of re-operation, extent of debridement, use of staged procedures) combined with different empiric-to-targeted antimicrobial regimens in adults with severe postoperative or post-traumatic deep surgical site infections and organ/space infections complicated by major complications (MCC). These studies enroll inpatients in the immediate perioperative period to evaluate short-term outcomes such as infection control, need for additional O.R. procedures, ICU utilization, and in-hospital mortality, providing evidence on which acute management pathways most effectively control infection while minimizing repeat operations. Results inform surgeons, infectious disease teams, and payers about resource intensity, potential to reduce length of stay and readmissions, and appropriate coding and reimbursement considerations for complex operative infection care.
    • Comparative effectiveness and bundled-care pathway studies: pragmatic trials or observational comparative-effectiveness research assessing multidisciplinary care bundles (standardized surgical protocols, antimicrobial stewardship, wound care pathways, and early rehabilitation) versus usual care for patients with postoperative or post-traumatic infections requiring O.R. procedures and presenting with MCC. These studies target heterogeneous inpatient populations (orthopedic prosthetic joint infections, intra-abdominal post-op infections, complex soft-tissue trauma infections) and examine outcomes such as number of reoperations, days of parenteral antibiotics, total hospital costs, and complication rates; they aim to identify which bundle components drive improved outcomes. Evidence from these studies is relevant to hospital administrators and payers for designing clinically effective, cost-conscious pathways that can reduce variation, lower complication-related expenditures, and support DRG-level care management.
    • Post-discharge outcomes, rehabilitation, and health services research: longitudinal cohort studies or registry-based analyses following survivors of complex postoperative/post-traumatic infections with MCC after hospital discharge to evaluate long-term functional recovery, durable infection eradication, outpatient antibiotic use, device removal/reimplantation rates, and unplanned readmissions. These investigations often focus on high-risk subgroups (patients needing long-term intravenous therapy, those with prosthetic devices, or patients with multiple comorbidities) to characterize drivers of late complications, durable quality of life, and total episode-of-care costs. Findings are critical for payers and case managers to plan post-acute support, outpatient antibiotic administration resources, and to model total cost implications beyond the index hospitalization that influence bundled payment arrangements and resource allocation decisions.

    Related Codes

    853-INFECTIOUS-AND-PARASITIC-DISEASES-WITH-O-R-PROCEDURES-WITH-MCC

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

    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

    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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    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.

    Mean Rates by Payer — National — DRG 856
    Mean Rates by Payer — Alaska — DRG 856