What is the relative weight of MS-DRG 404 for FY2027?

3.2513. The relative weight is multiplied by the hospital's blended base rate to produce the payment, so above 1.0 means above-average reimbursement for the stay.

What is the length of stay for MS-DRG 404?

The FY2027 geometric mean length of stay is 4.60 days and the arithmetic mean is 5.70 days. The geometric mean is the one CMS uses for the post-acute transfer policy, which applies to this DRG.

Which diagnoses group to MS-DRG 404?

4 ICD-10-CM codes are routed to MS-DRGs 403–404 as principal diagnosis in the CMS MS-DRG definitions manual; which of 403–404 the case lands in depends on whether a secondary diagnosis qualifies as a CC or MCC. The most-searched are T84.53XA (infection and inflammatory reaction due to internal right knee prosthesis, initial encounter), T84.54XA (infection and inflammatory reaction due to internal left knee prosthesis, initial encounter), T84.51XA (infection and inflammatory reaction due to internal right hip prosthesis, initial encounter), T84.52XA (infection and inflammatory reaction due to internal left hip prosthesis, initial encounter).

404

MS-DRG 404 — HIP OR KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTION WITHOUT MCC

DRGSurgicalMDC 08

MS-DRG 404 is hip or knee procedures with principal diagnosis of periprosthetic joint infection without mcc, in MDC 08 (a surgical DRG), at the without-CC/MCC level. Its FY2027 relative weight is 3.2513, so a case here pays more than the average Medicare inpatient stay (weight 1.0), with a geometric mean length of stay of 4.60 days. 4 ICD-10-CM principal diagnoses group into MS-DRGs 403–404 under the CMS definitions manual; the most-searched are listed below.

FY2027 payment factors

Relative weight: 3.2513
Geometric mean LOS: 4.60
Arithmetic mean LOS: 5.70
Post-acute transfer: Yes

This DRG is subject to the post-acute care transfer policy: a discharge to a qualifying setting below the mean length of stay is paid per diem rather than in full.

Principal diagnoses that group to MS-DRGs 403–404

From the CMS MS-DRG definitions manual’s principal-diagnosis index: 4 ICD-10-CM codes route here, and the CC/MCC status of the secondary diagnoses decides which of 403–404 the case lands in. The 4 most-searched:

T84.53XAInfection and inflammatory reaction due to internal right knee prosthesis, initial encounter
T84.54XAInfection and inflammatory reaction due to internal left knee prosthesis, initial encounter
T84.51XAInfection and inflammatory reaction due to internal right hip prosthesis, initial encounter
T84.52XAInfection and inflammatory reaction due to internal left hip prosthesis, initial encounter

Common questions

What is MS-DRG 404?: MS-DRG 404 is hip or knee procedures with principal diagnosis of periprosthetic joint infection without mcc, in MDC 08 (a surgical DRG), at the without-CC/MCC level. Its FY2027 relative weight is 3.2513, so a case here pays more than the average Medicare inpatient stay (weight 1.0), with a geometric mean length of stay of 4.60 days. 4 ICD-10-CM principal diagnoses group into MS-DRGs 403–404 under the CMS definitions manual; the most-searched are listed below.
What is the relative weight of MS-DRG 404 for FY2027?: 3.2513. The relative weight is multiplied by the hospital's blended base rate to produce the payment, so above 1.0 means above-average reimbursement for the stay.
What is the length of stay for MS-DRG 404?: The FY2027 geometric mean length of stay is 4.60 days and the arithmetic mean is 5.70 days. The geometric mean is the one CMS uses for the post-acute transfer policy, which applies to this DRG.
Which diagnoses group to MS-DRG 404?: 4 ICD-10-CM codes are routed to MS-DRGs 403–404 as principal diagnosis in the CMS MS-DRG definitions manual; which of 403–404 the case lands in depends on whether a secondary diagnosis qualifies as a CC or MCC. The most-searched are T84.53XA (infection and inflammatory reaction due to internal right knee prosthesis, initial encounter), T84.54XA (infection and inflammatory reaction due to internal left knee prosthesis, initial encounter), T84.51XA (infection and inflammatory reaction due to internal right hip prosthesis, initial encounter), T84.52XA (infection and inflammatory reaction due to internal left hip prosthesis, initial encounter).

Other DRGs in MDC 08

The with-MCC, with-CC and without-CC/MCC splits usually sit next to each other here. Those are what a documentation query is actually deciding between, and the weight gap between them is why the query is worth raising.

400KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION2.0248
402SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL4.0967
403HIP OR KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTION WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER5.0061
426MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC9.9191
427MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC6.7049
428MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC5.9222
429COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC8.8363
430COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC5.8956
447MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC6.9667
448MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC4.3506
449REVISION OF HIP OR KNEE PROSTHESIS3.2995
450SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC5.2340
451SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC3.2600
456SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, OR INFECTION WITH MCC7.6244
457SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, OR INFECTION WITH CC5.3668
458SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, OR INFECTION WITHOUT CC/MCC4.0388
461BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC4.9707
462BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC2.8540
463WOUND DEBRIDEMENT OR SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER5.1296
464WOUND DEBRIDEMENT OR SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC3.1764
465WOUND DEBRIDEMENT OR SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC2.4822
469MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT3.1085
470MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC1.9563
471CERVICAL SPINAL FUSION WITH MCC4.9370
472CERVICAL SPINAL FUSION WITH CC2.9811
473CERVICAL SPINAL FUSION WITHOUT CC/MCC2.4518
474AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER4.2144
475AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC2.2249
476AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC1.1360
477BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER3.4040
478BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC2.4337
479BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC1.8542
480HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER2.9204
481HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC2.1265
482HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC1.6397
483MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES2.8966
488KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC2.2211
489KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC1.3122
492LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC OR INSERTION OF ANTIBIOTIC-ELUTING BONE VOID FILLER3.6914
493LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC2.5528

Working the claim behind this DRG

A DRG is assigned from the diagnoses and procedures already on the claim, so the questions that decide MS-DRG 404 are coding questions. Look the principal diagnosis up in the full ICD-10-CM tabular list with its Excludes1 and “code first” notes attached, or start from the condition instead of the code in the codes-by-condition index. For the secondary diagnoses that move a case between the with-MCC, with-CC and without-CC/MCC splits, paste the whole set into the free claim scrubber and see which pairs collide before the claim goes out — no account, no card.

The supplies, drugs and devices billed alongside an inpatient stay are HCPCS Level II, listed in full at HCPCS by section. If the claim comes back rejected, the denial code index explains what each CARC actually means and what to do about it, and the decision guides walk the sequencing calls that most often cause one — sepsis and diabetes above all.

Every one of those is free and needs no account. This page is the payment table: it says what MS-DRG 404 is worth. Which medical DRG a set of diagnoses lands in is the workspace’s DRG impact check, from the CMS CC/MCC lists; it does not group surgical cases.