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    v1.0.28
    OpenPayerBilling CodesInjuries, Poisonings and Toxic Effects of DrugsDRG 921-complications-of-treatment-without-cc-mcc
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    Complications of Treatment without CC/MCC: Inpatient Reimbursement Overview

    DRG 921 addresses inpatient admissions for complications of treatment without Major Complication or Comorbidity and without Complication or Comorbidity. It defines the clinical scope for lower-severity treatment complications and matters for Medicare inpatient reimbursement because it determines grouping and relative payment for these resource-use profiles.

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    DRG 921 Overview

    DRG 921 covers hospital admissions for complications of medical or surgical treatment that do not qualify as a Major Complication or Comorbidity and do not meet Complication or Comorbidity criteria. Typical cases include postoperative infections, adverse drug reactions, device malfunctions, and non-severe procedure-related complications requiring inpatient care. This Diagnosis-Related Group matters for Medicare payment because it groups lower-severity treatment complications into a distinct reimbursement category that affects payment relative to the principal diagnosis and resource use. Hospitals and coders must correctly capture complication codes and principal procedures to ensure appropriate Medicare inpatient payment alignment.

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    Clinical Trials

    • Acute perioperative complication management studies: randomized or observational studies testing protocols to rapidly identify and treat common in-hospital complications arising from procedures (for example, post-procedural bleeding, device-related infections, or medication-induced adverse events) in surgical and procedural patients without major comorbidities. These trials enroll adult inpatients who develop a complication of treatment during an index hospitalization and evaluate short-term interventions, diagnostic algorithms, or care pathways to shorten time-to-resolution and reduce escalation to higher-acuity care. Results inform clinicians and payers about resource use, appropriate escalation criteria, and cost-effective acute management strategies for patients assigned to this DRG.
    • Comparative effectiveness studies of process-of-care bundles to prevent escalation: pragmatic trials or multicenter cohort studies comparing different standardized in-hospital response bundles (for example, wound-care protocols, device-check algorithms, or medication-reconciliation and adverse-event monitoring bundles) intended to prevent progression from a treatable complication to a complication with CC/MCC. These studies target hospitalized patients who are at risk of or have early signs of treatment complications, assessing rates of complication resolution, length of stay, readmissions, and utilization of ICU or advanced therapies. Findings are directly relevant to hospital quality improvement, DRG case-mix management, and payer decisions about coverage for bundled care pathways that may lower downstream costs.
    • Post-discharge outcomes and readmission-prevention research: longitudinal cohort studies and interventional trials testing post-acute follow-up strategies (such as structured outpatient surveillance, telehealth monitoring, or targeted home health interventions) for patients discharged after inpatient treatment complications without CC/MCC. These studies focus on functional recovery, late sequelae of the complication, 30- and 90-day readmission rates, and patient-reported outcomes in a population that had a manageable in-hospital complication but may be vulnerable to recurrence or delayed consequences. Evidence from this research guides discharge planning, transitional-care reimbursements, and payer investments in outpatient supports that reduce readmissions and total cost of care for this DRG group.

    Related Codes

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

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

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.