Summary & Overview
Pulmonary Embolism without MCC: Inpatient Reimbursement Overview
DRG 176 addresses hospital stays for pulmonary embolism without Major Complication or Comorbidity and defines a mid‑level payment grouping under the Medicare Severity Diagnosis-Related Group framework. It matters for inpatient reimbursement because DRG assignment drives Medicare payment rates and reflects the expected resource intensity for these admissions.
DRG 176 Overview
DRG 176 covers inpatient admissions for pulmonary embolism without a Major Complication or Comorbidity (MCC). It includes cases where pulmonary embolism is the principal diagnosis and the clinical course does not meet MCC or CC thresholds, affecting length of stay and resource use. This DRG matters for Medicare payment because it places these admissions in a mid‑level payment category under the Medicare Severity Diagnosis-Related Group (MS-DRG) system. Accurate coding and documentation determine assignment to 176 and therefore the facility's reimbursement.
National Payment Rates
Mean rates range from $5,736.98 for Medicare to $13,913.48 for Aetna, with a wide spread driven largely by variation across commercial payers versus Medicare. Commercial plans such as Aetna, Cigna, and Anthem tend to report higher mean payments compared with Medicare. See the table and chart below for payer-level means and percentile distributions.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments reported under the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for Diagnosis-Related Group .
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