Summary & Overview

Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh: Inpatient Reimbursement Overview

DRG 538 addresses inpatient admissions for sprains, strains, and dislocations of the hip, pelvis, and thigh without Complication or Comorbidity or Major Complication or Comorbidity, representing lower-acuity musculoskeletal injuries. Proper Diagnosis-Related Group assignment matters for inpatient reimbursement because it determines the Medicare fixed-payment grouping and reflects expected resource use for these straightforward cases.

Sprains, Strains, and Dislocations of Hip, Pelvis and ThighDRG Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without CC/MCCDRG 538Diagnosis-Related GroupInpatient ReimbursementMedicareOrthopedicsTraumaHip DislocationMusculoskeletal Injury

DRG 538 Overview

DRG 538 covers inpatient stays for sprains, strains, and dislocations of the hip, pelvis, and thigh without Complication or Comorbidity or Major Complication or Comorbidity. This Diagnosis-Related Group captures cases that are generally less complex and resource-intensive than those with complicating conditions. It matters for Medicare payment because the Diagnosis-Related Group assignment determines the fixed inpatient reimbursement amount, influencing hospital payment for routine surgical and nonoperative management of these musculoskeletal injuries. Accurate coding and documentation of the absence of Complication or Comorbidity and Major Complication or Comorbidity are essential to assign DRG 538 correctly.

Clinical Trials

Acute management trials evaluating emergency and perioperative interventions for high-grade hip, pelvis, or thigh dislocations and severe sprains/strains: these studies focus on immediate treatment strategies such as timing and techniques of closed or open reduction, anesthesia approaches, and acute stabilization protocols in adult patients presenting to the ED or admitted for observation. They assess short-term outcomes like pain control, neurovascular status, complication rates (e.g., avascular necrosis risk after hip dislocation), and length of stay. Results inform inpatient clinical pathways and resource needs that directly affect hospital costs and utilization for this DRG.
Comparative effectiveness studies of different inpatient rehabilitation and early mobilization strategies following reduction or surgical repair: randomized or pragmatic trials compare protocols such as standardized inpatient physical therapy intensity, weight-bearing restrictions, and multimodal pain management versus usual care in older adults and working-age patients with hip/pelvis/thigh injuries. These investigations target functional recovery, readmission rates, discharge disposition (home vs skilled nursing), and time to return to baseline mobility — outcomes that influence both clinical decision-making and payer-covered post-acute resource allocation.
Post-discharge outcomes and health services research evaluating long-term functional outcomes, complications, and costs for patients treated for hip/pelvis/thigh sprains, strains, or dislocations without major comorbidities: observational cohort studies and registry analyses follow patients after hospital discharge to measure persistent pain, re-injury rates, need for subsequent procedures, and downstream healthcare utilization. This research identifies predictors of poor recovery and high-cost trajectories, helping providers optimize risk stratification during the index admission and payers design coverage policies and care management programs for this relatively lower-acuity DRG.

Related Codes

472-CERVICAL-SPINAL-FUSION-WITH-CC

Cervical Spinal Fusion with CC: Inpatient Reimbursement Overview

558-TENDONITIS-MYOSITIS-AND-BURSITIS-WITHOUT-MCC

Tendonitis, Myositis and Bursitis without MCC: Inpatient Reimbursement Overview

555-SIGNS-AND-SYMPTOMS-OF-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-WITH-MCC

Signs and Symptoms of Musculoskeletal System and Connective Tissue with MCC: Inpatient Reimbursement Overview

533-FRACTURES-OF-FEMUR-WITH-MCC

Fractures of Femur with Major Complication or Comorbidity: Inpatient Reimbursement Overview

479-BIOPSIES-OF-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-WITHOUT-CC-MCC

Biopsies of Musculoskeletal System and Connective Tissue without CC/MCC: Inpatient Reimbursement Overview

540-OSTEOMYELITIS-WITH-CC

Osteomyelitis with Complication or Comorbidity: Inpatient Reimbursement Overview

475-AMPUTATION-FOR-MUSCULOSKELETAL-SYSTEM-AND-CONNECTIVE-TISSUE-DISORDERS-WITH-CC

Amputation for Musculoskeletal System and Connective Tissue Disorders with CC: Inpatient Reimbursement Overview

473-CERVICAL-SPINAL-FUSION-WITHOUT-CC-MCC

Cervical Spinal Fusion without CC/MCC: Inpatient Reimbursement Overview

500-SOFT-TISSUE-PROCEDURES-WITH-MCC

Soft Tissue Procedures with MCC: Inpatient Reimbursement Overview

486-KNEE-PROCEDURES-WITH-PRINCIPAL-DIAGNOSIS-OF-INFECTION-WITH-CC

Knee Procedures with Principal Diagnosis of Infection with CC: Inpatient Reimbursement Overview

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