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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 862-postoperative-and-post-traumatic-infections-with-mcc
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    Postoperative and Post-Traumatic Infections with MCC: Inpatient Reimbursement Overview

    DRG 862 includes inpatient stays for postoperative and post-traumatic infections with a Major Complication or Comorbidity, reflecting complex clinical care needs. It matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases resource-intensity and therefore Medicare payment under the inpatient prospective payment system.

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    DRG 862 Overview

    DRG 862 covers inpatient admissions for postoperative and post-traumatic infections associated with a Major Complication or Comorbidity, typically requiring extended antimicrobial therapy, operative management, or complex wound care. These cases often involve higher resource use due to intensive monitoring, surgical debridement, and prolonged hospitalization, which increases Medicare payment relative to less complicated infectious diagnoses. Proper DRG assignment affects hospital reimbursement under the inpatient prospective payment system administered by the Centers for Medicare & Medicaid Services. Accurate coding of the underlying infection, associated procedures, and presence of a Major Complication or Comorbidity determines payment eligibility for DRG 862.

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    National Payment Rates

    Across commercial payers the observed rate range runs roughly from $16K to $66K, with the widest spread between Anthem at a high near $66K and BCBS at the low end near $16K. The payer table below and accompanying chart show payer-level distributions and quartiles for Anthem, Aetna, Cigna, and BCBS. Variability is notable across national commercial plans, with median payments clustering in the mid-to-high $20Ks.

    The CMS 2023 data reflect national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($17.4k), average submitted covered charges ($79.7k), average Medicare payment amount ($14.2k), and total discharges (10.9k).

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $17K$80K$14K11K

    Patient Population

    This DRG population includes a mix of Medicare and commercial enrollees but skews toward Medicare-age patients given the higher utilization among older adults; many discharges are from beneficiaries in the standard Medicare age bands rather than exclusively working-age. Commercial payers still cover a meaningful share, so the population is mixed rather than solely Medicare or solely working-age. Payer mix assessments should therefore consider both Medicare-dominant utilization and a nontrivial commercial component.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Payer rates in Alaska for DRG 862 cluster between $28K and $73K, with Anthem and Blue Cross Blue Shield both reporting a fixed $28K and Cigna’s median at $43K and max at $73K. The most notable deviation from national averages is Cigna’s substantially higher mean of $44K in Alaska versus its broader national distribution. See the table and chart below for full payer-specific details.

    Key Insights for Alaska

    • Highest payer: Cigna (median $43K; max $73K) and lowest payer: Anthem and Blue Cross Blue Shield (both fixed at $28K).
    • Alaska’s rates show Cigna paying materially above Anthem/BCBS, with Cigna’s mean $44K notably higher than the state’s Anthem/BCBS $28K and also above the national median range for Cigna.

    Clinical Trials

    • Acute antimicrobial strategy trials: randomized or adaptive studies comparing different empiric and targeted antimicrobial regimens, dosing strategies (including extended or continuous infusions), and duration of therapy for hospitalized patients with postoperative or post-traumatic surgical site infections complicated by major complications (eg, sepsis, organ dysfunction). These studies enroll adults who develop deep or organ/space infections after surgery or trauma and require inpatient management; they address questions about early optimization of therapy to rapidly control infection and limit progression to multiorgan failure. Results are directly relevant to clinicians for bedside antibiotic selection and to payers because effective early treatment can reduce ICU stays, readmissions, and resource intensity for this high-cost DRG.
    • Source control and procedural timing trials: comparative effectiveness or pragmatic trials evaluating different approaches and timing for surgical or interventional source control (eg, reoperation, drainage techniques, use of open versus closed wound management) in patients with postoperative or post-traumatic infections with major complications. These studies focus on heterogeneous inpatient populations who present with deep incisional or organ/space infections where the optimal timing and method of source control is uncertain, measuring outcomes such as resolution of infection, need for additional procedures, length of stay, and complication rates. Findings inform surgical and interventional decision-making, helping providers standardize care pathways and helping payers and hospitals model costs and utilization tied to procedure choices and timing.
    • Post-discharge outcomes and care-coordination studies: observational cohorts or pragmatic randomized studies testing interventions such as enhanced discharge planning, outpatient antimicrobial stewardship programs, home IV therapy protocols, and remote monitoring for patients discharged after treatment for postoperative or post-traumatic infections with major complications. These investigations enroll survivors of the index hospitalization who are at risk for readmission, device-related complications, or long-term functional impairment, and they assess readmission rates, outpatient resource use, patient-reported outcomes, and total episode-of-care costs. This research is important to providers and payers because improved transitional care can reduce costly readmissions and downstream utilization associated with this DRG while supporting recovery and quality-of-life metrics.

    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

    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

    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 862
    Mean Rates by Payer — Alaska — DRG 862