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MS-DRG 427 · MDC 08 · Surgical

MS-DRG 427: Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: IPPS Table 5 FY2027 final rule (effective October 1, 2026); Definitions Manual v44 (effective October 1, 2026). Next CMS release: April 1, 2027 (v44.1 mid-year update), then the FY2028 final rule in August 2027.

Key facts for DRG 427

FY2027 relative weight
6.7020
Higher than 95% of all MS-DRGs
Change vs FY2026
-7.2%
FY2026 weight 7.2190
Geometric mean LOS
3.7 days
Arithmetic mean 4.4 days
MDC
08
Diseases and Disorders of the Musculoskeletal System and Connective Tissue
Severity level
with CC (complication or comorbidity)
Transfer policy
Post-acute transfer DRG
Special-pay DRG

TL;DR

MS-DRG 427 is a surgical group in MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) at the middle severity level of its family. CMS assigns it a FY2027 relative weight of 6.7020 with a geometric mean length of stay of 3.7 days and an arithmetic mean of 4.4. Its weight moved down 7.2% from FY2026 (7.2190). That weight is higher than 95% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 426, DRG 428) spans weights 5.9200 to 9.9190. The v44 Definitions Manual assigns it through 230 operating room procedures codes.

What changed from FY2026 to FY2027

CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 427 the FY2027 relative weight is 6.7020 against 7.2190 in FY2026, a fall of 7.16%, which exceeds the 2% threshold worth re-checking in contract models.

FY2026 versus FY2027 payment factors for MS-DRG 427
MetricFY2026FY2027Change
Relative weight7.21906.7020-0.5170
Geometric mean LOS (days)4.03.7-0.3
Arithmetic mean LOS (days)4.84.4-0.4
Weights shown are the FY2027 final values after the 10% cap on year-over-year reductions where applicable.

CC and MCC family

DRG 427 shares its base definition with 2 other MS-DRGs split by severity. The family's weights span 5.9200 to 9.9190, a 1.68× spread, which is the payment effect of documenting qualifying complications and comorbidities.

MS-DRGs in the same base group as DRG 427
DRGTitleFY2027 weightGMLOS
426Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC9.91906.7
427Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC6.70203.7
428Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC5.92002.5

Grouper logic (v44 Definitions Manual)

Operating Room Procedures: 230 ICD-10 codes drive assignment to this group; the first 12 are shown.

Operating Room Procedures codes assigned to DRG 427 (sample)
ICD-10 codeDescription
0RG6070Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior Approach, Anterior Column, Open Approach
0RG607JFusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior Approach, Anterior Column, Open Approach
0RG60A0Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach
0RG60AJFusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior Approach, Anterior Column, Open Approach
0RG60J0Fusion of Thoracic Vertebral Joint with Synthetic Substitute, Anterior Approach, Anterior Column, Open Approach
0RG60JJFusion of Thoracic Vertebral Joint with Synthetic Substitute, Posterior Approach, Anterior Column, Open Approach
0RG60K0Fusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Anterior Approach, Anterior Column, Open Approach
0RG60KJFusion of Thoracic Vertebral Joint with Nonautologous Tissue Substitute, Posterior Approach, Anterior Column, Open Approach
0RG6370Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior Approach, Anterior Column, Percutaneous Approach
0RG637JFusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior Approach, Anterior Column, Percutaneous Approach
0RG63A0Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Percutaneous Approach
0RG63AJFusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior Approach, Anterior Column, Percutaneous Approach

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 427 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.

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Frequently asked questions — DRG 427

What is MS-DRG 427?

MS-DRG 427 is "Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC", 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 427?

The FY2027 relative weight is 6.7020 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 7.2190, a change of -7.2%.

What is the average length of stay for DRG 427?

CMS reports a geometric mean length of stay of 3.7 days and an arithmetic mean of 4.4 days for FY2027. The geometric mean is used for transfer-payment calculations.

Which DRGs are in the same CC/MCC family as 427?

DRG 426 (Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC, weight 9.9190); DRG 428 (Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC, weight 5.9200). The family's weights range from 5.9200 to 9.9190, so documented complications and comorbidities change payment materially.

What documentation supports the severity level of DRG 427?

DRG 427 is reached when the stay carries a secondary diagnosis from the CMS Complication or Comorbidity list but none from the MCC list. Common CC captures include chronic kidney disease stage 3 and above, uncontrolled diabetes with manifestations, malnutrition of specified severity and heart failure of a stated type. Each must be documented by the treating clinician and show clinical relevance in the record; a condition listed only in the problem list without assessment is the most frequent reason a CC is removed on audit and the stay drops to the base DRG.

Which codes group to DRG 427?

The v44 Definitions Manual lists 230 operating room procedures codes for this group. Examples from the operating room procedures list: 0RG6070 (Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Anterior Approach, Anterior Column, Open Approach); 0RG607J (Fusion of Thoracic Vertebral Joint with Autologous Tissue Substitute, Posterior Approach, Anterior Column, Open Approach); 0RG60A0 (Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach); 0RG60AJ (Fusion of Thoracic Vertebral Joint with Interbody Fusion Device, Posterior Approach, Anterior Column, Open Approach).

Is DRG 427 a post-acute transfer DRG?

Yes. CMS flags DRG 427 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.

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.