Septicemia or Severe Sepsis without MV >96 Hours with MCC DRG Reimbursement

Summary & Overview

Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

DRG 871 addresses inpatient admissions for septicemia or severe sepsis without prolonged mechanical ventilation but with at least one Major Complication or Comorbidity, reflecting higher clinical complexity. Correct assignment influences Medicare inpatient reimbursement because the Diagnosis-Related Group determines relative payment rates tied to expected resource use.

Septicemia or Severe Sepsis without MV >96 Hours with MCCDRG Septicemia or Severe Sepsis without MV >96 Hours with MCCDRG 871Diagnosis-Related GroupInpatient ReimbursementMedicareInfectious DiseaseCritical CareHospital CodingSepsis

DRG 871 Overview

DRG 871 covers inpatient stays for patients treated for septicemia or severe sepsis who do not require mechanical ventilation for more than 96 hours and have at least one Major Complication or Comorbidity. This Diagnosis-Related Group captures higher-acuity infectious and systemic inflammatory cases where resource use is increased due to the presence of serious comorbid conditions. It matters for Medicare payment because classification into this Diagnosis-Related Group drives higher reimbursement relative to lower-severity groups, reflecting greater expected hospital resource consumption. Accurate coding of sepsis and Major Complication or Comorbidity documentation directly affects assignment to DRG 871 and associated payment.

National Payment Rates

Across payers the observed rate range runs from about $18K (BCBS) up to $65K (Anthem), with a mean-centered spread where payer means fall between roughly $18K and $32K; the widest single-payer spread (min-to-max) is seen with Anthem (min ~$390 to max $65K). See the accompanying table and chart below for payer-level detail. Payer comparisons use national commercial plan samples (Cigna, Aetna, Anthem, BCBS).

Mean Rates by Payer — National — DRG 871

The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 871 based on 2023 claims.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Payer mean rates in Alaska range from about $29K to $48K across the reported payers, with Cigna at the high end (mean $48K, max $83K) and Anthem and Blue Cross Blue Shield clustered at the low end (mean $29K, max $48K). The state displays a wide top-end spread driven by Cigna’s $83K maximum, which is a notable deviation above national averages. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna (max $83K, mean $48K, median $46K) is the top-paying payer in Alaska, substantially above other local payers.
Lowest payer: Anthem/Blue Cross Blue Shield (both share identical benchmarks with max $48K, mean $29K, median $30K) are the lowest-paying payers in the state.
Alaska’s mean rates skew higher than national means for similar payers (Cigna’s mean $48K notably exceeds national Cigna mean $32K), indicating a meaningful upward deviation at the top end of the market.

Clinical Trials

Acute immunomodulatory or sepsis bundle intervention trials: randomized studies testing timing and components of early sepsis care bundles (e.g., fluid strategies, vasopressor initiation thresholds, source-control timing and adjunctive immunomodulatory therapies) in adult inpatients presenting with septicemia or severe sepsis who do not require prolonged mechanical ventilation. These trials focus on the initial 24–72 hours of hospitalization to determine whether specific acute interventions reduce organ dysfunction, intensive care utilization, or mortality. Results directly inform inpatient care pathways, resource use, and short-term cost drivers relevant to payers and hospital reimbursement under this high-acuity DRG.
Comparative effectiveness studies of antimicrobial stewardship and diagnostic strategies: pragmatic trials or cohort studies comparing rapid molecular pathogen/ resistance testing plus targeted antimicrobial therapy versus standard culture-driven approaches in patients with bloodstream infections and severe sepsis without prolonged ventilation. These studies enroll heterogeneous hospitalized adults with sepsis to evaluate time to appropriate therapy, antibiotic exposure, length of stay, and rates of complications or readmission. Findings influence antibiotic costs, length-of-stay and downstream readmission risks that affect reimbursement and case-mix adjustment for this DRG.
Post-acute outcomes and care-transition research: longitudinal cohort studies or interventional trials testing discharge planning models, early outpatient follow-up, and rehabilitation interventions aimed at reducing post-discharge morbidity, functional decline, and 30–90 day readmissions among survivors of septicemia/severe sepsis without prolonged mechanical ventilation. These studies target patients discharged from the inpatient stay classified under this DRG to quantify long-term resource utilization, patient-centered outcomes, and preventable readmissions. Results are relevant to payers and hospitals seeking to improve bundled-payment performance and reduce avoidable downstream costs associated with sepsis survivors.

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

866-VIRAL-ILLNESS-WITHOUT-MCC

Viral Illness without MCC: Inpatient Reimbursement Overview

870-SEPTICEMIA-OR-SEVERE-SEPSIS-WITH-MV-96-HOURS

Septicemia or Severe Sepsis with MV >96 Hours: Inpatient Reimbursement Overview

869-OTHER-INFECTIOUS-AND-PARASITIC-DISEASES-DIAGNOSES-WITHOUT-CC-MCC

Other Infectious and Parasitic Diseases Diagnoses without CC/MCC: Inpatient Reimbursement Overview

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

Postoperative and Post-Traumatic Infections without 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

865-VIRAL-ILLNESS-WITH-MCC

Viral Illness with 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

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

Infectious and Parasitic Diseases 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

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OpenPayer

Summary & Overview

Septicemia or Severe Sepsis without MV >96 Hours with MCC: Inpatient Reimbursement Overview

DRG 871 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