Summary & Overview
Vaginal Delivery with Sterilization and/or D&C with CC: Inpatient Reimbursement Overview
DRG 797 addresses vaginal delivery cases that include sterilization and/or dilation and curettage with a Complication or Comorbidity, defining the clinical scope for payment. This classification matters for inpatient reimbursement because it alters the Diagnosis-Related Group weight and thus affects hospital Medicare payment for the admission.
DRG 797 Overview
DRG 797 covers inpatient admissions for vaginal delivery combined with sterilization and/or dilation and curettage with the presence of a Complication or Comorbidity. It captures cases where additional procedures during the admission increase resource use beyond a routine vaginal delivery. This Diagnosis-Related Group matters for Medicare payment because the presence of a Complication or Comorbidity adjusts the relative payment weight and influences hospital reimbursement. Accurate coding and documentation of the procedures and associated conditions determine assignment to this Diagnosis-Related Group.
National Payment Rates
Across national commercial payers the observed rate distribution runs from a low of $370 up to $31K, with payer medians ranging roughly from $7.3K to $14K. The widest spread between minimum and maximum reported rates is $31K (Anthem). See the table and chart below for payer-specific percentiles and distributions.
The CMS 2023 data represent national Medicare fee-for-service inpatient payments from the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($8.6k), average submitted covered charges ($36.5k), average Medicare payment amount ($6.5k), and total discharges (41).
State Payment Rates
State: Alaska1 / 49
Alaska Benchmarks
Alaska exhibits a narrow rate band for DRG 797, with Anthem and Blue Cross Blue Shield clustered at $16K and Cigna notably higher at a mean of $24K (max $40K). This represents a meaningful upward deviation for Cigna from many national medians, while Anthem/Blue Cross Blue Shield remain below typical national levels. See the table and chart below for payer-specific distributions.
Key Insights for Alaska
- Anthem is the lowest payer in Alaska at $16K, while Cigna is the highest with a mean of $24K (range up to $40K).
- Alaska’s payer range ($16K–$24K) is compressed compared with national spreads; Cigna’s mean at $24K meaningfully exceeds national averages for several payers, while Anthem and Blue Cross Blue Shield sit below typical national medians.
Clinical Trials
- Acute perioperative safety and complication reduction studies: Trials focusing on immediate intraoperative and early postoperative outcomes for patients undergoing vaginal delivery combined with sterilization or dilation and curettage (D&C). These studies enroll patients who elect for sterilization at the time of vaginal delivery or require D&C for retained products, and evaluate interventions such as standardized surgical checklists, local hemostatic techniques, or optimized anesthesia protocols to reduce hemorrhage, infection, and procedure-related morbidity. Findings are relevant to clinicians and payers because reducing short-term complications can decrease length of stay, readmissions, and resource utilization associated with this DRG.
- Comparative effectiveness and timing research on sterilization approaches: Prospective comparative studies that evaluate different timing strategies (immediate postpartum sterilization versus delayed interval sterilization) and different procedural approaches performed in the setting of a vaginal delivery with concurrent D&C. These trials enroll birthing persons considering permanent contraception and compare outcomes including procedure success, patient satisfaction, unintended pregnancy rates, and system-level barriers such as consent timing and access; they are important to providers and payers because optimal timing and approach can influence operative time, need for additional procedures, and downstream costs for family planning services.
- Post-discharge recovery, health economics, and quality-of-life cohorts: Observational and pragmatic studies that follow patients after hospital discharge to measure recovery trajectories, postpartum mental health, lactation outcomes, and health-care utilization for those who had vaginal delivery with sterilization and/or D&C with complications (CC). These studies often include patient-reported outcomes and cost analyses over 30–365 days to capture readmissions, outpatient visits, and contraceptive counseling needs; results inform care pathways, resource allocation, and reimbursement planning by identifying drivers of prolonged recovery and opportunities to reduce avoidable downstream costs associated with this DRG.
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