Key facts for DRG 403
- FY2027 relative weight
- 5.0050
- Higher than 92% of all MS-DRGs
- Change vs FY2026
- New DRG
- No FY2026 weight
- Geometric mean LOS
- 9.0 days
- Arithmetic mean 11.2 days
- MDC
- 08
- Diseases and Disorders of the Musculoskeletal System and Connective Tissue
- Severity level
- with MCC (major complication or comorbidity)
- Transfer policy
- Post-acute transfer DRG
- Special-pay DRG
TL;DR
MS-DRG 403 is a surgical group in MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) at the highest-severity level of its family. CMS assigns it a FY2027 relative weight of 5.0050 with a geometric mean length of stay of 9.0 days and an arithmetic mean of 11.2. It is new for FY2027, so there is no prior-year weight to compare. That weight is higher than 92% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 404) spans weights 3.2520 to 5.0050. The v44 Definitions Manual assigns it through 303 operating room procedures codes and 4 periprosthetic joint infection codes.
What changed from FY2026 to FY2027
DRG 403 is new in the v44 grouper effective October 1, 2026, so there is no FY2026 weight to compare. Review the FY2027 final rule Table 6 series for the code moves that created it and confirm that your encoder and contract modeling have loaded v44.
CC and MCC family
DRG 403 shares its base definition with 1 other MS-DRG split by severity. The family's weights span 3.2520 to 5.0050, a 1.54× spread, which is the payment effect of documenting qualifying complications and comorbidities.
| DRG | Title | FY2027 weight | GMLOS |
|---|---|---|---|
| 403 | Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection with MCC or Insertion of Antibiotic-eluting Bone Void Filler | 5.0050 | 9.0 |
| 404 | Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection without MCC | 3.2520 | 4.6 |
Grouper logic (v44 Definitions Manual)
Operating Room Procedures: 303 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0M9L4ZZ | Drainage of Right Hip Bursa and Ligament, Percutaneous Endoscopic Approach |
| 0M9M4ZZ | Drainage of Left Hip Bursa and Ligament, Percutaneous Endoscopic Approach |
| 0QBG0ZZ | Excision of Right Tibia, Open Approach |
| 0QBG3ZZ | Excision of Right Tibia, Percutaneous Approach |
| 0QBG4ZZ | Excision of Right Tibia, Percutaneous Endoscopic Approach |
| 0QBH0ZZ | Excision of Left Tibia, Open Approach |
| 0QBH3ZZ | Excision of Left Tibia, Percutaneous Approach |
| 0QBH4ZZ | Excision of Left Tibia, Percutaneous Endoscopic Approach |
| 0QC60ZZ | Extirpation of Matter from Right Upper Femur, Open Approach |
| 0QC63ZZ | Extirpation of Matter from Right Upper Femur, Percutaneous Approach |
| 0QC64ZZ | Extirpation of Matter from Right Upper Femur, Percutaneous Endoscopic Approach |
| 0QC70ZZ | Extirpation of Matter from Left Upper Femur, Open Approach |
Periprosthetic Joint Infection: 4 ICD-10 codes drive assignment to this group.
| ICD-10 code | Description |
|---|---|
| T8451XA | Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter |
| T8452XA | Infection and inflammatory reaction due to internal left hip prosthesis, initial encounter |
| T8453XA | Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter |
| T8454XA | Infection and inflammatory reaction due to internal left knee prosthesis, initial encounter |
Documentation and denial exposure
As a surgical DRG, assignment depends on a qualifying operating-room procedure being coded from the operative report; a missing or non-OR procedure code drops the stay into a medical DRG in MDC 08 with a lower weight. Because this family splits by severity, auditors target CC and MCC capture: each secondary diagnosis must be documented as present, monitored, evaluated or treated during the stay to survive a DRG-validation review. Typical inpatient denial codes for this group: CARC 16 (claim lacks information needed to group the stay), CARC 50 (the admission or procedure is judged not medically necessary), CARC 97 (a service is bundled into the DRG payment).
How QuickIntell uses DRG 403 data
QuickCode groups inpatient encounters against the current v44 logic, flags CC and MCC candidates that lack supporting documentation, and shows the weight difference across the family before the claim drops. QuickScribe captures the attending's language that supports severity, and QuickRCM works DRG-validation denials with the grouper evidence attached.
Frequently asked questions — DRG 403
What is MS-DRG 403?
MS-DRG 403 is "Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection with MCC or Insertion of Antibiotic-eluting Bone Void Filler", a surgical Medicare Severity Diagnosis-Related Group in MDC 08, Diseases and Disorders of the Musculoskeletal System and Connective Tissue. Medicare pays inpatient stays grouped here at the hospital's base rate multiplied by the DRG relative weight.
What is the FY2027 relative weight for DRG 403?
The FY2027 relative weight is 5.0050 (IPPS final rule Table 5, effective October 1, 2026). The DRG is new for FY2027.
What is the average length of stay for DRG 403?
CMS reports a geometric mean length of stay of 9.0 days and an arithmetic mean of 11.2 days for FY2027. The geometric mean is used for transfer-payment calculations.
Which DRGs are in the same CC/MCC family as 403?
DRG 404 (Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joint Infection without MCC, weight 3.2520). The family's weights range from 3.2520 to 5.0050, so documented complications and comorbidities change payment materially.
What documentation supports the severity level of DRG 403?
DRG 403 requires at least one secondary diagnosis on the CMS Major Complication or Comorbidity list, documented as present and clinically addressed during the stay (monitored, evaluated, treated or extending the stay). Conditions such as acute respiratory failure, severe sepsis or acute kidney injury with specified cause qualify only when the attending's note states the diagnosis itself, not just the lab values. Recovery auditors downgrade this group to the CC or base level when the MCC rests on an unconfirmed query or a resolved historical condition, so the query response and the discharge summary must agree.
Which codes group to DRG 403?
The v44 Definitions Manual lists 303 operating room procedures codes and 4 periprosthetic joint infection codes for this group. Examples from the operating room procedures list: 0M9L4ZZ (Drainage of Right Hip Bursa and Ligament, Percutaneous Endoscopic Approach); 0M9M4ZZ (Drainage of Left Hip Bursa and Ligament, Percutaneous Endoscopic Approach); 0QBG0ZZ (Excision of Right Tibia, Open Approach); 0QBG3ZZ (Excision of Right Tibia, Percutaneous Approach).
Is DRG 403 a post-acute transfer DRG?
Yes. CMS flags DRG 403 under the post-acute care transfer policy, so a discharge to a qualifying post-acute setting before the geometric mean length of stay is paid a per-diem amount rather than the full DRG payment. It is also a special-pay DRG.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.
- IPPS FY2027 Final Rule Table 5 (CMS-1849-F)Version v44 FY2027 · effective 2026-10-01 · file CMS-1849-F Table 5.txtSHA-256 01003dd571c1e2f5…
- IPPS FY2026 Final Rule Table 5 (CMS-1833-F)Version v43 FY2026 · effective 2025-10-01 · file CMS-1833-F Table 5.txtSHA-256 bf8c390d14b3cd3e…
- ICD-10 MS-DRG Definitions Manual v44 (text)Version v44 · effective 2026-10-01 · file fy2027-fr-icd10-ms-drg-definitions-manual-files-v44.zipSHA-256 ae4f6c11727fe91f…
Disclaimer
This page is an operational reference compiled from the CMS IPPS FY2027 final rule (Table 5) and the v44 ICD-10 MS-DRG Definitions Manual. Relative weights are national factors; actual payment depends on each hospital's wage-adjusted base rate, add-ons, outliers and transfer adjustments. Nothing here is legal, clinical or billing advice; verify grouping against your encoder and the published CMS files.