Summary & Overview
Coronary Bypass without Cardiac Catheterization without MCC: Inpatient Reimbursement Overview
DRG 236 applies to inpatient admissions for coronary artery bypass grafting without cardiac catheterization and without a Major Complication or Comorbidity; it captures isolated bypass surgical episodes. This Diagnosis-Related Group is important for inpatient reimbursement because it determines the bundled Medicare payment associated with the procedure and documented comorbidity level.
DRG 236 Overview
DRG 236 covers inpatient admissions for coronary artery bypass grafting without concurrent cardiac catheterization and without a Major Complication or Comorbidity. This Diagnosis-Related Group applies to patients undergoing isolated coronary bypass procedures where no major additional diagnoses elevate payment. It matters for Medicare payment because it defines the bundled payment amount for the surgical hospitalization based on procedure and comorbidity profile. Accurate assignment influences hospital reimbursement and resource categorization for cardiac surgical care.
National Payment Rates
Across payers the observed rate range spans roughly from $1.1K to $140K, with mean rates clustering between about $36K and $68K depending on payer. The widest spread is seen between the lowest and highest observed values (about $1.1K to $140K). See the table and chart below for payer-specific distributions for Anthem, Aetna, Cigna, and BCBS.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS 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 DRG 236.
State Payment Rates
State: Alaska1 / 49
Alaska Benchmarks
Payer rates in Alaska for DRG 236 span a wide range, with medians clustering at $65K for Anthem and BCBS and $100K for Cigna; mean values reflect similar divergence. The most notable deviation from national averages is Cigna’s substantially higher median and upper-percentile values (median $100K, max $180K) compared with national medians around the mid-$60Ks. Reference the table and chart below for percentile and distribution details.
Key Insights for Alaska
- Anthem is the lowest paying payer in AK with a median of $65K, while Cigna is the highest with a median of $100K.
- AK rates range from about $7.5K (Anthem/BCBS minimums) up to $180K (Cigna maximum), showing wider spread than typical national medians and notably higher upper-end outliers driven by Cigna.
Clinical Trials
- Acute perioperative optimization trials: studies focused on interventions immediately before, during, or after isolated coronary artery bypass grafting (CABG) without cardiac catheterization, such as enhanced hemodynamic protocols, blood conservation strategies, or perfusion management techniques. These trials enroll patients undergoing planned or urgent isolated CABG who do not have concurrent catheter-based procedures, and they measure intraoperative stability, transfusion requirements, operative complications, and short-term ICU length of stay. This research is relevant because improved perioperative practices can reduce operative morbidity and resource use, directly affecting hospital costs and DRG-related reimbursement for providers and payers.
- Comparative effectiveness studies of conduit choice and surgical technique: pragmatic trials or cohort studies comparing outcomes of different graft conduits (for example, single versus bilateral internal mammary artery use, or radial artery versus saphenous vein grafts) and variations in surgical approach in patients receiving isolated CABG without catheterization. These studies target typical CABG populations stratified by age, comorbidity (diabetes, renal dysfunction), and coronary disease pattern, assessing graft patency, repeat revascularization, functional status, and mid-term survival. Findings inform surgeons and payers about which techniques produce better durable outcomes and lower downstream utilization, influencing clinical pathways, quality metrics, and cost-effectiveness considerations under the DRG.
- Post-discharge recovery and secondary prevention outcomes research: observational cohorts or randomized trials evaluating cardiac rehabilitation enrollment, adherence to guideline-directed medical therapy, wound-care strategies, and readmission reduction programs for patients after discharge from isolated CABG hospitalizations. These studies follow patients in the weeks to years after surgery to measure hospital readmissions, complications such as sternal wound infection, medication adherence, functional recovery, and total post-acute care costs. This area matters to providers and payers because successful post-discharge management reduces costly readmissions and improves long-term outcomes that impact overall value within the DRG payment episode.
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