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    v1.0.30
    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 864-fever-and-inflammatory-conditions
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    Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

    DRG 864 addresses inpatient admissions for fever and inflammatory conditions, encompassing diagnostic evaluation and management of undifferentiated febrile illness and systemic inflammation. This classification matters for inpatient reimbursement because it bundles facility payment for the episode of care, making clinical documentation and coding critical to appropriate Medicare payment.

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    DRG 864 Overview

    DRG 864 covers admissions primarily for fever and inflammatory conditions, including systemic inflammatory responses, undifferentiated febrile illnesses, and related diagnostic evaluation and management. These cases often involve broad-spectrum testing, antimicrobial management, and supportive care, which can drive resource use during an inpatient stay. For Medicare payment, classification under this Diagnosis-Related Group groups similar clinical presentations to determine bundled reimbursement for hospital services. Accurate documentation of presenting symptoms, infectious workup, and any complications is central to correct assignment and payment.

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    Clinical Trials

    • Acute diagnostic and biomarker validation studies: trials focused on rapid diagnostic algorithms and validation of inflammatory biomarkers to differentiate infectious from non-infectious causes of fever in hospitalized adults and children. These studies enroll patients presenting with new-onset fever and systemic inflammatory signs during an inpatient stay or emergency admission, evaluating combinations of laboratory markers, imaging, and clinical scoring systems to improve early etiologic diagnosis. Accurate diagnostics can reduce unnecessary antibiotic use, shorten length of stay, and inform appropriate resource utilization, which is directly relevant to clinicians and payers managing costs and quality for DRG 864 admissions.
    • Comparative effectiveness trials of initial inpatient management strategies: comparative studies assessing different approaches to initial inpatient care, such as observation versus early targeted therapy, heterogenous empiric antimicrobial stewardship protocols, or bundled sepsis-screening-plus-fluid-management pathways in febrile patients without a definitive source. These trials typically enroll adult medical inpatients with fever and inflammatory conditions who do not meet clear criteria for immediate invasive interventions, comparing clinical outcomes, complication rates, and hospital resource use across strategies. Findings inform decisions about protocols that can reduce complications, readmissions, and variable costs, helping providers standardize care and payers predict and control episode-of-care expenditures for this DRG.
    • Post-discharge outcomes and healthcare utilization cohorts: longitudinal observational studies tracking patients discharged after hospitalization for fever and inflammatory conditions to measure rates of readmission, unresolved inflammatory disease, late infectious complications, and functional recovery across different discharge plans and follow-up intensities. These studies include diverse patient groups such as elderly patients with comorbidities, immunocompromised hosts, and pediatric patients to identify predictors of poor post-discharge outcomes and effective transitional-care interventions. Results help health systems and payers design targeted post-acute care pathways, allocate follow-up resources, and develop risk-adjusted reimbursement models tied to downstream utilization for DRG 864 cases.

    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

    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

    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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