MS-DRG 473: Cervical Spinal Fusion without CC/MCC
Cervical fusion uncomplicated
Typical indications
- ACDF for radiculopathy
Common denial patterns
- 6wk conservative care minimum
- Imaging not supporting nerve root compression
Appeal angles
Document conservative trial + imaging.
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. 473 has relative weight 2.5234. 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 473?
Cervical Spinal Fusion without CC/MCC. Cervical fusion uncomplicated.
What are typical indications?
ACDF for radiculopathy.
Why are claims under this DRG denied?
6wk conservative care minimum; Imaging not supporting nerve root compression.
How do I appeal?
Document conservative trial + imaging.
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