HIV with Extensive O.R. Procedures with MCC: Inpatient Reimbursement Overview

DRG 969 pertains to hospitalizations for human immunodeficiency virus infection requiring extensive operating room procedures with at least one Major Complication or Comorbidity, defining a high-acuity inpatient surgical cohort. Proper assignment affects Medicare inpatient reimbursement by reflecting elevated resource use and influencing payment weights and expected length of stay.

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DRG 969 Overview

DRG 969 covers hospital admissions for patients with human immunodeficiency virus infection who undergo extensive operating room procedures and have at least one Major Complication or Comorbidity. This Diagnosis-Related Group captures high-resource surgical care and complex inpatient management that significantly affects Medicare reimbursement. The classification influences payment weight and length-of-stay expectations for Centers for Medicare & Medicaid Services claims processing. It is relevant for surgical, infectious disease, and inpatient case management coding and billing.

Clinical Trials

Acute perioperative infection control trials: Studies testing intraoperative and immediate postoperative strategies to reduce surgical site infections and sepsis among people living with HIV undergoing extensive operative procedures. These trials enroll hospitalized PLWH who require multiple or major OR interventions, comparing interventions such as optimized perioperative antibiotic timing, enhanced wound care protocols, or immune-modulating perioperative bundles. Results help providers reduce morbidity and shorten ICU/ward stays, and help payers by identifying protocols that lower costs associated with complications and readmissions.
Comparative effectiveness studies of anesthesia and pain management regimens in immunocompromised surgical patients: Trials comparing regional versus general anesthesia strategies, multimodal analgesia pathways, or opioid-sparing approaches specifically in patients with advanced HIV or associated comorbidities undergoing extensive surgery. These studies focus on intra- and post-operative respiratory, hemodynamic, and infectious outcomes in a population at higher risk for complications, informing perioperative care pathways that can improve recovery and resource utilization for hospitals and insurers.
Post-discharge outcomes and care coordination research: Cohort and intervention studies evaluating transitions of care, adherence to antiretroviral therapy, wound follow-up, and rehospitalization prevention among PLWH after discharge following major OR procedures. These projects assess metrics like 30- and 90-day readmissions, outpatient wound healing, and linkage to home health or specialty follow-up, providing evidence for care models that reduce costly readmissions and support value-based reimbursement strategies.

HIV with Extensive O.R. Procedures without MCC: Inpatient Reimbursement Overview

974-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-MCC

HIV with Major Related Condition with MCC: Inpatient Reimbursement Overview

975-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-CC

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

976-HIV-WITH-MAJOR-RELATED-CONDITION-WITHOUT-CC-MCC

HIV with Major Related Condition without CC/MCC: Inpatient Reimbursement Overview

977-HIV-WITH-OR-WITHOUT-OTHER-RELATED-CONDITION

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

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 perioperative infection control trials: Studies testing intraoperative and immediate postoperative strategies to reduce surgical site infections and sepsis among people living with HIV undergoing extensive operative procedures. These trials enroll hospitalized PLWH who require multiple or major OR interventions, comparing interventions such as optimized perioperative antibiotic timing, enhanced wound care protocols, or immune-modulating perioperative bundles. Results help providers reduce morbidity and shorten ICU/ward stays, and help payers by identifying protocols that lower costs associated with complications and readmissions.
Comparative effectiveness studies of anesthesia and pain management regimens in immunocompromised surgical patients: Trials comparing regional versus general anesthesia strategies, multimodal analgesia pathways, or opioid-sparing approaches specifically in patients with advanced HIV or associated comorbidities undergoing extensive surgery. These studies focus on intra- and post-operative respiratory, hemodynamic, and infectious outcomes in a population at higher risk for complications, informing perioperative care pathways that can improve recovery and resource utilization for hospitals and insurers.
Post-discharge outcomes and care coordination research: Cohort and intervention studies evaluating transitions of care, adherence to antiretroviral therapy, wound follow-up, and rehospitalization prevention among PLWH after discharge following major OR procedures. These projects assess metrics like 30- and 90-day readmissions, outpatient wound healing, and linkage to home health or specialty follow-up, providing evidence for care models that reduce costly readmissions and support value-based reimbursement strategies.

HIV with Extensive O.R. Procedures without MCC: Inpatient Reimbursement Overview

974-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-MCC

HIV with Major Related Condition with MCC: Inpatient Reimbursement Overview

975-HIV-WITH-MAJOR-RELATED-CONDITION-WITH-CC

HIV with Major Related Condition with CC: Inpatient Reimbursement Overview

976-HIV-WITH-MAJOR-RELATED-CONDITION-WITHOUT-CC-MCC

HIV with Major Related Condition without CC/MCC: Inpatient Reimbursement Overview

977-HIV-WITH-OR-WITHOUT-OTHER-RELATED-CONDITION

HIV with or without Other Related Condition: Inpatient Reimbursement Overview

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.

HIV with Extensive O.R. Procedures with MCC: Inpatient Reimbursement Overview

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DRG 969 Overview

HIV with Extensive O.R. Procedures with MCC: Inpatient Reimbursement Overview

Sign up for drg 969 policy alerts

DRG 969 Overview

Clinical Trials

Related Codes

References

Clinical Trials

Related Codes

References