Other O.R. Procedures for Injuries with MCC DRG Reimbursement

Summary & Overview

Other O.R. Procedures for Injuries with MCC: Inpatient Reimbursement Overview

DRG 907 encompasses other operating room procedures for injuries when a Major Complication or Comorbidity is present, focusing on traumatic operative care with significant clinical complexity. Classification into this Diagnosis-Related Group matters for inpatient reimbursement because it affects hospital payment under the Centers for Medicare & Medicaid Services inpatient prospective payment framework.

Other O.R. Procedures for Injuries with MCCDRG Other O.R. Procedures for Injuries with MCCDRG 907Diagnosis-Related GroupInpatient ReimbursementMedicareTrauma SurgeryOrthopedic SurgeryGeneral SurgeryOperating Room Procedures

DRG 907 Overview

DRG 907 covers inpatient encounters for patients undergoing other operating room procedures related to injuries when a Major Complication or Comorbidity is present. This group captures cases with significant clinical complexity that typically drive higher resource use due to the combination of traumatic operative interventions and severe comorbid conditions. It matters for Medicare payment because classification into this Diagnosis-Related Group influences hospital reimbursement levels under the inpatient prospective payment system. Accurate coding of the principal procedure, injury diagnoses, and presence of a Major Complication or Comorbidity affects case assignment to this Diagnosis-Related Group and thus payment.

National Payment Rates

Across payers the observed mean payment benchmarks range roughly from $35K (BCBS) up to $63K (Cigna), with individual payer medians and percentiles shown in the table and chart below. The widest spread between payer means is about $28K (Cigna vs. BCBS). Benchmark detail is shown for Cigna, Aetna, Anthem, and BCBS in the table and chart that follow.

Mean Rates by Payer — National — DRG 907

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 ($38.5k), average submitted covered charges ($179.4k), average Medicare payment amount ($32.7k), and total discharges (8.8k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

For DRG 907 in Alaska the mean payments range from $60K (Anthem and Blue Cross Blue Shield) up to $92K (Cigna), indicating a modest payor spread within the state. Cigna’s mean of $92K is the most notable deviation above the other state payers and sits higher than many national median values. See the table and chart below for payer-level detail.

Key Insights for Alaska

Highest payer: Cigna at a mean of $92K; Lowest payers: Anthem and BCBS both at a mean of $60K.
Alaska shows a narrow cluster at $60K for Anthem and Blue Cross Blue Shield, with Cigna substantially higher, creating a notable state-level spread compared with national medians where payers are more distributed.

Clinical Trials

Trials evaluating perioperative blood management strategies for patients undergoing non-routine operative procedures for traumatic injuries: These studies focus on reducing transfusion requirements and optimizing hemostasis in patients with varied injury patterns who require uncommonly coded OR procedures (e.g., complex soft-tissue reconstructions, debridements, or limb-salvage operations). The population typically includes adult trauma inpatients with significant bleeding risk or coagulopathy; endpoints include transfusion volume, perioperative complications, and length of stay. This research matters to providers and payers because improved blood management can reduce complication-related costs, ICU time, and readmissions in a heterogeneous surgical-injury cohort common to this DRG.
Comparative effectiveness studies of operative techniques and resource use for complex injury repairs categorized outside standard procedure groups: These trials compare different surgical approaches (for example, staged debridement versus single-stage reconstruction, or minimally invasive fixation versus open repair) in patients whose injuries require atypical OR procedures included in this DRG. The studies enroll diverse injury types and severities to assess outcomes such as functional recovery, reoperation rates, device utilization, and total inpatient costs. Findings guide surgeons and hospital administrators on procedure selection that balances clinical effectiveness with inpatient resource utilization and DRG-based reimbursement constraints.
Post-discharge outcomes and care-coordination research examining rehabilitation, complication surveillance, and readmission prevention after non-standard operative injury care: These prospective cohort studies follow patients after discharge who underwent uncommon operative procedures for injuries to measure functional outcomes, wound complication rates, durability of repair, and patterns of acute-care reuse. The target population is often medically complex trauma patients with comorbidities or social needs that affect recovery; interventions studied include structured follow-up pathways, home health integration, or enhanced wound surveillance. Results are relevant to payers and providers because reducing preventable readmissions and optimizing post-acute care allocation can improve cost-effectiveness and quality metrics for admissions assigned to this DRG.

Related Codes

913-TRAUMATIC-INJURY-WITH-MCC

Traumatic Injury with MCC: Inpatient Reimbursement Overview

909-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITHOUT-CC-MCC

Other O.R. Procedures for Injuries without CC/MCC: Inpatient Reimbursement Overview

922-OTHER-INJURY-POISONING-AND-TOXIC-EFFECT-DIAGNOSES-WITH-MCC

Other Injury, Poisoning and Toxic Effect Diagnoses with MCC: Inpatient Reimbursement Overview

903-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITHOUT-CC-MCC

Wound Debridements for Injuries without CC/MCC: Inpatient Reimbursement Overview

902-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITH-CC

Wound Debridements for Injuries with CC: Inpatient Reimbursement Overview

919-COMPLICATIONS-OF-TREATMENT-WITH-MCC

Complications of Treatment with Major Complication or Comorbidity: Inpatient Reimbursement Overview

920-COMPLICATIONS-OF-TREATMENT-WITH-CC

Complications of Treatment with CC: Inpatient Reimbursement Overview

901-WOUND-DEBRIDEMENTS-FOR-INJURIES-WITH-MCC

Wound Debridements for Injuries with MCC: Inpatient Reimbursement Overview

905-SKIN-GRAFTS-FOR-INJURIES-WITHOUT-CC-MCC

Skin Grafts for Injuries without CC/MCC: Inpatient Reimbursement Overview

908-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITH-CC

Other O.R. Procedures for Injuries with CC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$39K	$180K	$33K	8.8K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 907

Key Insights for Alaska

Highest payer: Cigna at a mean of $92K; Lowest payers: Anthem and BCBS both at a mean of $60K.
Alaska shows a narrow cluster at $60K for Anthem and Blue Cross Blue Shield, with Cigna substantially higher, creating a notable state-level spread compared with national medians where payers are more distributed.

Clinical Trials

Trials evaluating perioperative blood management strategies for patients undergoing non-routine operative procedures for traumatic injuries: These studies focus on reducing transfusion requirements and optimizing hemostasis in patients with varied injury patterns who require uncommonly coded OR procedures (e.g., complex soft-tissue reconstructions, debridements, or limb-salvage operations). The population typically includes adult trauma inpatients with significant bleeding risk or coagulopathy; endpoints include transfusion volume, perioperative complications, and length of stay. This research matters to providers and payers because improved blood management can reduce complication-related costs, ICU time, and readmissions in a heterogeneous surgical-injury cohort common to this DRG.
Comparative effectiveness studies of operative techniques and resource use for complex injury repairs categorized outside standard procedure groups: These trials compare different surgical approaches (for example, staged debridement versus single-stage reconstruction, or minimally invasive fixation versus open repair) in patients whose injuries require atypical OR procedures included in this DRG. The studies enroll diverse injury types and severities to assess outcomes such as functional recovery, reoperation rates, device utilization, and total inpatient costs. Findings guide surgeons and hospital administrators on procedure selection that balances clinical effectiveness with inpatient resource utilization and DRG-based reimbursement constraints.
Post-discharge outcomes and care-coordination research examining rehabilitation, complication surveillance, and readmission prevention after non-standard operative injury care: These prospective cohort studies follow patients after discharge who underwent uncommon operative procedures for injuries to measure functional outcomes, wound complication rates, durability of repair, and patterns of acute-care reuse. The target population is often medically complex trauma patients with comorbidities or social needs that affect recovery; interventions studied include structured follow-up pathways, home health integration, or enhanced wound surveillance. Results are relevant to payers and providers because reducing preventable readmissions and optimizing post-acute care allocation can improve cost-effectiveness and quality metrics for admissions assigned to this DRG.