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    v1.0.30
    OpenPayerBilling CodesHuman Immunodeficiency Virus InfectionsDRG 970-hiv-with-extensive-o-r-procedures-without-mcc
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    HIV with Extensive O.R. Procedures without MCC: Inpatient Reimbursement Overview

    DRG 970 encompasses inpatient stays for human immunodeficiency virus infection requiring extensive operating room procedures without a Major Complication or Comorbidity; it defines a surgical-heavy case mix within HIV care. Understanding this Diagnosis-Related Group is important for inpatient reimbursement because it determines bundled Medicare payment levels based on the intensity of operative services and coded comorbidities.

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    DRG 970 Overview

    DRG 970 covers hospital inpatient stays for patients with human immunodeficiency virus infection who undergo extensive operating room procedures without a Major Complication or Comorbidity. This Diagnosis-Related Group captures cases with significant surgical resource use in the setting of human immunodeficiency virus care but without higher-severity comorbid conditions. It matters for Medicare payment because it groups similar clinical and resource profiles to determine bundled reimbursement for the inpatient episode. Accurate coding of procedures and comorbidities directly affects payment classification within this Diagnosis-Related Group.

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    Clinical Trials

    • Acute perioperative management studies focused on optimizing surgical outcomes for people with advanced HIV undergoing extensive operating room procedures. These studies enroll hospitalized adult patients with HIV who require major operations (e.g., abdominal, thoracic, or multi-cavity procedures) to evaluate strategies such as antimicrobial prophylaxis timing, perioperative immune and viral load monitoring, and protocols for antiretroviral therapy (ART) interruption versus continuation. Findings are directly relevant to inpatient providers for reducing surgical complications and to payers for understanding drivers of length of stay and high-cost resource use associated with complex operative courses.
    • Comparative effectiveness trials assessing different intraoperative and immediate postoperative approaches to reduce complications and rehospitalization in immunocompromised surgical patients. Trials may compare enhanced infection prevention bundles, transfusion thresholds, or intensified wound care regimens in cohorts of people with HIV with varying CD4 counts or comorbidities (e.g., hepatitis coinfection, substance use). Results inform clinical pathways and bundled payment models by identifying which perioperative strategies lower complication rates, ICU days, and downstream costs in this high-risk DRG group.
    • Post-discharge outcomes and care-transition research examining rehabilitation needs, adherence to antiretroviral therapy, and long-term functional recovery after extensive surgery in people living with HIV. These observational or interventional studies follow patients after discharge to measure readmissions, wound complication rates, ART continuity, and quality-of-life metrics, often stratified by baseline immunologic status and social determinants of health. Such evidence guides discharge planning, outpatient resource allocation, and payer decisions about coverage for home health, rehabilitation, and case management to reduce readmissions and total cost of care.

    Related Codes

    969-HIV-WITH-EXTENSIVE-O-R-PROCEDURES-WITH-MCC

    HIV with Extensive O.R. Procedures with 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. 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 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.