MS-DRG
MS-DRG 469: Major Joint Replacement or Reattachment of Lower Extremity with MCC
THA/TKA + MCC
DRG
469
MDC
MDC 08: Musculoskeletal
Severity
with MCC
Relative weight
3.9234
Avg LOS
5.7 days
Typical indications
- THA + sepsis
- TKA + DVT
Common denial patterns
- MCC validation
Appeal angles
Document MCC + joint replacement criteria.
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. 469 has relative weight 3.9234. 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.
Frequently asked questions
What is MS-DRG 469?
Major Joint Replacement or Reattachment of Lower Extremity with MCC. THA/TKA + MCC.
What are typical indications?
THA + sepsis; TKA + DVT.
Why are claims under this DRG denied?
MCC validation.
How do I appeal?
Document MCC + joint replacement criteria.
Streamline DRG 469 workflow with ApprovalHelp
Pre-built clinical documentation templates for DRG-level CDI and denial response. no setup fee.
Get started →Contact: hello@approvalhelp.com