DRG 853 Overview

DRG 853 covers hospital admissions for infectious and parasitic diseases that require operating room procedures and include at least one Major Complication or Comorbidity. Typical cases include complex surgical source control or debridement for severe infections, often involving critical care and extended resource use. This grouping matters for Medicare payment because the presence of operating room procedures and a Major Complication or Comorbidity increases relative reimbursement to reflect higher resource intensity. Accurate documentation and coding of procedures and comorbid conditions determine assignment to this Diagnosis-Related Group.

Across commercial payers the observed rate range runs from about $43K (BCBS) up to $81K (Cigna), with Anthem and Aetna clustering around $73K–$80K. The widest spread between payer medians is roughly $32K (BCBS median $44K vs. Cigna median $75K). See the table and chart below for full payer percentile detail and distribution.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($44.6k), average submitted covered charges ($216.0k), average Medicare payment amount ($39.0k), and total discharges (82.3k).

• Acute surgical antimicrobial strategies: randomized or pragmatic trials evaluating perioperative and intraoperative antimicrobial regimens, timing of source-control procedures, and adjunctive sepsis bundles in patients with severe infectious or parasitic diseases who require operative intervention and have major comorbidities (MCC). These studies enroll critically ill inpatients admitted for emergency or planned O.R. procedures for infections such as complicated intra-abdominal sepsis, necrotizing soft tissue infections, or infected prosthetic material, and test endpoints like early organ dysfunction reversal, need for reoperation, and in-hospital mortality. Findings directly inform surgical timing, antibiotic stewardship, and resource use during the highest-cost inpatient phase, which is crucial for clinicians making acute care decisions and for payers managing reimbursement and utilization for DRG 853 admissions.
• Comparative effectiveness and pathway trials for operative source control techniques: multicenter observational cohorts or randomized studies comparing different O.R. procedures and surgical approaches (for example, open versus minimally invasive source control, staged debridement schedules, or use of negative-pressure therapy) in patients with complex infectious conditions and significant comorbidity burden. These trials focus on functional recovery, complication rates, length of stay, and need for additional surgical interventions among medically complex inpatients who qualify for this DRG. Results help hospitals and payers understand which procedural pathways reduce readmissions, downstream resource use, and costs while maintaining clinical outcomes for high-acuity infectious disease surgical cases.
• Post-discharge outcomes and care-transition studies: prospective observational studies or interventions assessing post-discharge trajectories, antimicrobial therapy adherence, outpatient parenteral antimicrobial therapy (OPAT) safety, and readmission risk stratification in survivors of O.R.-treated infectious diseases with MCC. These investigations enroll patients discharged after operative management for severe infections to evaluate 30- to 90-day readmissions, complications related to comorbid conditions, and the effectiveness of care coordination programs or telehealth follow-up. Evidence from this area is important for payers and providers seeking to reduce costly readmissions, optimize transitional care pathways, and allocate resources toward post-acute services that improve outcomes for patients in DRG 853.