MS-DRG 460: Spinal Fusion Except Cervical without MCC

Typical indications

• DDD with instability
• Spondylolisthesis

Common denial patterns

• Conservative therapy <6 mo
• Imaging not supporting fusion

Appeal angles

Document 6mo failed conservative care, imaging w/ instability/spondylolisthesis.

Context: how MS-DRGs work

MS-DRGs bundle hospital inpatient payment into a single amount per admission. Each DRG has a relative weight that multiplies the hospital's base rate to determine payment. 460 has relative weight 5.3842. Major Complication or Comorbidity (MCC) and Complication or Comorbidity (CC) secondary diagnoses can move a case to a higher-paying DRG within the same family.