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

DRG 919 addresses inpatient admissions for complications of treatment accompanied by a Major Complication or Comorbidity, encompassing serious treatment-related adverse events that increase resource use. It matters for inpatient reimbursement because higher-severity cases in this Diagnosis-Related Group receive greater Medicare payments to account for additional clinical complexity and costs.

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DRG 919 Overview

DRG 919 covers inpatient hospital admissions for complications of medical or surgical treatment when a Major Complication or Comorbidity is present. This group captures patients who experience serious treatment-related adverse events that require additional resources, extended stays, or intensified interventions. It is important for Medicare payment because cases assigned to this Diagnosis-Related Group typically generate higher reimbursement to reflect the increased cost and complexity of care associated with major complications of treatment.

Clinical Trials

Acute interventional trials evaluating prevention and management of immediate iatrogenic complications: studies in this area focus on rapid-response interventions to treat complications such as postoperative hemorrhage, device-related infections, medication-induced organ dysfunction, or procedural perforations. The patient population typically includes inpatients who develop severe treatment-related complications with major complications or comorbidities (MCC) that require urgent escalation of care, intensive monitoring, or surgical re-intervention. These trials are relevant to providers and payers because they assess effectiveness, timing, and resource use of acute interventions that drive length of stay, ICU utilization, and short-term costs for patients assigned to this DRG.
Comparative effectiveness and safety studies of alternative management strategies for complex treatment complications: these studies compare different clinical pathways (for example conservative vs. invasive management, different surgical techniques, or antimicrobial stewardship approaches for device-related infections) in patients who have developed significant treatment-related complications with high severity. The studied population often includes medically complex inpatients with MCCs where clinician choice impacts complication resolution, readmission risk, and downstream resource utilization. Payers and hospital decision-makers rely on this evidence to determine cost-effective care bundles, guideline development, and reimbursement policies that balance clinical outcomes with expenditures for high-risk patients in this DRG.
Post-discharge outcomes and care coordination studies focused on long-term sequelae and readmission prevention: research here evaluates transitional care interventions, rehabilitation strategies, and monitoring programs aimed at reducing 30- and 90-day readmissions and functional decline among patients discharged after an inpatient stay complicated by treatment-related MCCs. The target population includes survivors of severe iatrogenic events who often have new disability, chronic wound or device needs, or recurrent infection risk, and who require structured outpatient follow-up and supportive services. Findings inform payers and providers on which post-discharge models reduce downstream costs, improve quality metrics, and support appropriate risk stratification and payment models for this high-cost DRG.

Wound Debridements for Injuries with MCC: Inpatient Reimbursement Overview

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

Wound Debridements for Injuries with CC: Inpatient Reimbursement Overview

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

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

904-SKIN-GRAFTS-FOR-INJURIES-WITH-CC-MCC

Skin Grafts for Injuries with CC/MCC: Inpatient Reimbursement Overview

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

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

906-HAND-PROCEDURES-FOR-INJURIES

Hand Procedures for Injuries: Inpatient Reimbursement Overview

907-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITH-MCC

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

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

Other O.R. Procedures for Injuries with CC: 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

913-TRAUMATIC-INJURY-WITH-MCC

Traumatic Injury with MCC: Inpatient Reimbursement Overview

Showing 1–10 of 19

References

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.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.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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Clinical Trials

Acute interventional trials evaluating prevention and management of immediate iatrogenic complications: studies in this area focus on rapid-response interventions to treat complications such as postoperative hemorrhage, device-related infections, medication-induced organ dysfunction, or procedural perforations. The patient population typically includes inpatients who develop severe treatment-related complications with major complications or comorbidities (MCC) that require urgent escalation of care, intensive monitoring, or surgical re-intervention. These trials are relevant to providers and payers because they assess effectiveness, timing, and resource use of acute interventions that drive length of stay, ICU utilization, and short-term costs for patients assigned to this DRG.
Comparative effectiveness and safety studies of alternative management strategies for complex treatment complications: these studies compare different clinical pathways (for example conservative vs. invasive management, different surgical techniques, or antimicrobial stewardship approaches for device-related infections) in patients who have developed significant treatment-related complications with high severity. The studied population often includes medically complex inpatients with MCCs where clinician choice impacts complication resolution, readmission risk, and downstream resource utilization. Payers and hospital decision-makers rely on this evidence to determine cost-effective care bundles, guideline development, and reimbursement policies that balance clinical outcomes with expenditures for high-risk patients in this DRG.
Post-discharge outcomes and care coordination studies focused on long-term sequelae and readmission prevention: research here evaluates transitional care interventions, rehabilitation strategies, and monitoring programs aimed at reducing 30- and 90-day readmissions and functional decline among patients discharged after an inpatient stay complicated by treatment-related MCCs. The target population includes survivors of severe iatrogenic events who often have new disability, chronic wound or device needs, or recurrent infection risk, and who require structured outpatient follow-up and supportive services. Findings inform payers and providers on which post-discharge models reduce downstream costs, improve quality metrics, and support appropriate risk stratification and payment models for this high-cost DRG.

Wound Debridements for Injuries with MCC: Inpatient Reimbursement Overview

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

Wound Debridements for Injuries with CC: Inpatient Reimbursement Overview

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

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

904-SKIN-GRAFTS-FOR-INJURIES-WITH-CC-MCC

Skin Grafts for Injuries with CC/MCC: Inpatient Reimbursement Overview

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

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

906-HAND-PROCEDURES-FOR-INJURIES

Hand Procedures for Injuries: Inpatient Reimbursement Overview

907-OTHER-O-R-PROCEDURES-FOR-INJURIES-WITH-MCC

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

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

Other O.R. Procedures for Injuries with CC: 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

913-TRAUMATIC-INJURY-WITH-MCC

Traumatic Injury with MCC: Inpatient Reimbursement Overview

Showing 1–10 of 19

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

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DRG 919 Overview

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

Sign up for drg 919 policy alerts

DRG 919 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References