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    OpenPayerBilling CodesFactors Influencing Health Status and Other Contacts with Health ServicesDRG 940-o-r-procedures-with-diagnoses-of-other-contact-with-health-services-with-cc
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    O.R. Procedures with Diagnoses of Other Contact with Health Services with CC: Inpatient Reimbursement Overview

    DRG 940 encompasses operating room procedures for encounters coded as other contact with health services when a Complication or Comorbidity is present. This classification identifies inpatient cases with additional complexity that affect Medicare inpatient reimbursement through Diagnosis-Related Group-based payment weighting.

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    DRG 940 Overview

    DRG 940 covers inpatient hospital admissions involving operating room procedures for patients classified with diagnoses of other contact with health services accompanied by a Complication or Comorbidity. This Diagnosis-Related Group groups cases where the principal procedures are surgical and the medical record documents conditions related to encounters for other specified health services, with an added level of complexity from the Complication or Comorbidity. It matters for Medicare payment because the classification affects base payment weights and resource allocation for hospitals under inpatient prospective payment systems. Accurate coding and documentation determine whether an admission is assigned to this Diagnosis-Related Group and thus influences reimbursement.

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    Clinical Trials

    • Acute perioperative safety and complication reduction studies: randomized or observational studies that evaluate interventions to reduce intraoperative or immediate postoperative complications (for example, optimized anesthesia protocols, hemostatic techniques, or infection-prevention bundles) in patients undergoing operating-room procedures coded under "other contact with health services" who also have a documented CC. These trials focus on the acute surgical encounter and high-risk inpatients—often older adults or medically complex patients with comorbid conditions contributing to the CC—to measure rates of surgical site infection, bleeding, respiratory events, or unplanned returns to the operating room. Results are directly relevant to providers and payers because reducing acute complications shortens length of stay, lowers resource utilization in the inpatient episode, and improves DRG-based reimbursement performance tied to complication rates.
    • Comparative effectiveness studies of perioperative management strategies: pragmatic trials or retrospective comparative analyses that compare different clinically plausible care pathways (for example, enhanced recovery protocols versus standard care; regional versus general anesthesia; or varying antibiotic prophylaxis durations) for patients undergoing O.R. procedures classified in this DRG with complicating CCs. These studies enroll heterogeneous inpatients who present for varied procedures classified as "other contact with health services" but share common management decisions that could affect outcomes such as postoperative morbidity, need for critical care, or readmission. Findings inform hospitals and payers about which strategies yield better outcomes and lower total cost of the inpatient episode, supporting value-based practice changes and guideline development for complex surgical patients.
    • Post-discharge outcomes and care transition research: cohort studies and interventions testing post-discharge follow-up models, early outpatient nursing or telehealth surveillance, or targeted rehabilitation programs for patients discharged after O.R. procedures with a CC. The population includes patients with persistent functional deficits, wound issues, or medical comorbidities that place them at elevated risk for readmission or prolonged recovery; research assesses readmission rates, post-acute care utilization, patient-centered outcomes, and cost implications. Such work is important to providers and payers because better transitional care can reduce costly readmissions and downstream services, improving overall episode-of-care performance under DRG-based payment systems.

    Related Codes

    939-O-R-PROCEDURES-WITH-DIAGNOSES-OF-OTHER-CONTACT-WITH-HEALTH-SERVICES-WITH-MCC

    O.R. Procedures with Diagnoses of Other Contact with Health Services with MCC: Inpatient Reimbursement Overview

    941-O-R-PROCEDURES-WITH-DIAGNOSES-OF-OTHER-CONTACT-WITH-HEALTH-SERVICES-WITHOUT-CC-MCC

    O.R. Procedures with Diagnoses of Other Contact with Health Services without CC/MCC: Inpatient Reimbursement Overview

    945-REHABILITATION-WITH-CC-MCC

    Rehabilitation with CC/MCC: Inpatient Reimbursement Overview

    946-REHABILITATION-WITHOUT-CC-MCC

    Rehabilitation without CC/MCC: Inpatient Reimbursement Overview

    947-SIGNS-AND-SYMPTOMS-WITH-MCC

    Signs and Symptoms with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    948-SIGNS-AND-SYMPTOMS-WITHOUT-MCC

    Signs and Symptoms without MCC: Inpatient Reimbursement Overview

    949-AFTERCARE-WITH-CC-MCC

    Aftercare with CC/MCC: Inpatient Reimbursement Overview

    950-AFTERCARE-WITHOUT-CC-MCC

    Aftercare without CC/MCC: Inpatient Reimbursement Overview

    951-OTHER-FACTORS-INFLUENCING-HEALTH-STATUS

    Other Factors Influencing Health Status: Inpatient Reimbursement Overview

    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.