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    OpenPayerBilling CodesInfectious and Parasitic Diseases, Systemic or Unspecified SitesDRG 868-other-infectious-and-parasitic-diseases-diagnoses-with-cc
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    Other Infectious and Parasitic Diseases Diagnoses with CC: Inpatient Reimbursement Overview

    DRG 868 encompasses other infectious and parasitic diseases with a Complication or Comorbidity and captures cases requiring inpatient resources beyond routine care. It matters for inpatient reimbursement because the Complication or Comorbidity designation influences the Diagnosis-Related Group relative weight and Centers for Medicare & Medicaid Services payment.

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    DRG 868 Overview

    DRG 868 covers hospital admissions for other infectious and parasitic diseases accompanied by a Complication or Comorbidity. This Diagnosis-Related Group groups patients whose infections require inpatient care but do not meet Major Complication or Comorbidity criteria, affecting average resource use and length of stay. It matters for Centers for Medicare & Medicaid Services inpatient payment because the presence of a Complication or Comorbidity adjusts relative weight and reimbursement compared with non-CC and Major Complication or Comorbidity categories. Accurate coding of infection diagnoses and associated Complication or Comorbidity is central to correct Medicare billing under this Diagnosis-Related Group.

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    Clinical Trials

    • Acute antimicrobial strategy trials: randomized or pragmatic trials comparing different initial inpatient antimicrobial approaches (such as broad-spectrum combination versus targeted therapy guided by rapid diagnostic tests) for serious non-specific infectious and parasitic conditions with complicating comorbidities. These studies enroll hospitalized adults who present with sepsis-spectrum or severe focal infections that do not fall into other DRG categories and often have CC-level complications (e.g., immunosuppression, organ dysfunction). Results inform early-treatment algorithms, antimicrobial stewardship, and inpatient resource utilization metrics important to clinicians and payers because early appropriate therapy influences length of stay, complication rates, and downstream costs.
    • Comparative effectiveness and diagnostic pathway studies: prospective cohorts or cluster-randomized trials evaluating different diagnostic workflows (rapid molecular diagnostics, imaging strategies, or biomarker-guided evaluation) and their impact on therapy selection and clinical outcomes for heterogeneous infectious/parasitic presentations grouped in this DRG. These studies focus on patients admitted with undifferentiated infections or parasitic diagnoses complicated by CCs, aiming to reduce diagnostic uncertainty, unnecessary broad-spectrum therapy, and delays to targeted treatment. Findings help hospitals and payers optimize care pathways, reduce avoidable testing or treatments, and improve coding and resource allocation for this catch-all DRG.
    • Post-discharge outcomes and care-transition studies: observational or interventional studies assessing readmission, long-term functional outcomes, adherence to outpatient antimicrobial therapy, and coordination of care after discharge for patients with complex infectious/parasitic diagnoses and comorbid CCs. These investigations target the high-risk subgroup within this DRG—patients with multi-morbidity or needing prolonged IV antibiotics—evaluating interventions such as enhanced discharge planning, outpatient parenteral antimicrobial therapy (OPAT) programs, or remote monitoring. Results are directly relevant to providers and payers because reducing readmissions and optimizing post-acute care pathways can substantially affect total episode costs and quality metrics associated with inpatient stays coded to this DRG.

    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

    864-FEVER-AND-INFLAMMATORY-CONDITIONS

    Fever and Inflammatory Conditions: Inpatient Reimbursement Overview

    865-VIRAL-ILLNESS-WITH-MCC

    Viral Illness with 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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