Key facts for DRG 461
- FY2027 relative weight
- 4.9710
- Higher than 91% of all MS-DRGs
- Change vs FY2026
- -10.0%
- FY2026 weight 5.5230
- Geometric mean LOS
- 6.2 days
- Arithmetic mean 8.3 days
- MDC
- 08
- Diseases and Disorders of the Musculoskeletal System and Connective Tissue
- Severity level
- with MCC (major complication or comorbidity)
- Transfer policy
- Not a transfer DRG
TL;DR
MS-DRG 461 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 4.9710 with a geometric mean length of stay of 6.2 days and an arithmetic mean of 8.3. Its weight moved down 10.0% from FY2026 (5.5230). That weight is higher than 91% of all surgical and medical MS-DRGs. Its CC/MCC family (DRG 462) spans weights 2.8530 to 4.9710. The v44 Definitions Manual assigns it through 477 right hip codes and 477 left hip codes and 368 right knee codes and 368 left knee codes and 5 right ankle codes and 5 left ankle codes.
What changed from FY2026 to FY2027
CMS recalibrates every MS-DRG weight annually from the prior year's MedPAR claims. For DRG 461 the FY2027 relative weight is 4.9710 against 5.5230 in FY2026, a fall of 9.99%, which exceeds the 2% threshold worth re-checking in contract models.
| Metric | FY2026 | FY2027 | Change |
|---|---|---|---|
| Relative weight | 5.5230 | 4.9710 | -0.5520 |
| Geometric mean LOS (days) | 5.9 | 6.2 | +0.3 |
| Arithmetic mean LOS (days) | 7.6 | 8.3 | +0.7 |
CC and MCC family
DRG 461 shares its base definition with 1 other MS-DRG split by severity. The family's weights span 2.8530 to 4.9710, a 1.74× spread, which is the payment effect of documenting qualifying complications and comorbidities.
| DRG | Title | FY2027 weight | GMLOS |
|---|---|---|---|
| 461 | Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC | 4.9710 | 6.2 |
| 462 | Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC | 2.8530 | 2.2 |
Grouper logic (v44 Definitions Manual)
Right Hip: 477 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0SR9019 | Replacement of Right Hip Joint with Metal Synthetic Substitute, Cemented, Open Approach |
| 0SR901A | Replacement of Right Hip Joint with Metal Synthetic Substitute, Uncemented, Open Approach |
| 0SR901Z | Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach |
| 0SR9029 | Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SR902A | Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SR902Z | Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach |
| 0SR9039 | Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Cemented, Open Approach |
| 0SR903A | Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Uncemented, Open Approach |
| 0SR903Z | Replacement of Right Hip Joint with Ceramic Synthetic Substitute, Open Approach |
| 0SR9049 | Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SR904A | Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SR904Z | Replacement of Right Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach |
Left Hip: 477 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0SRB019 | Replacement of Left Hip Joint with Metal Synthetic Substitute, Cemented, Open Approach |
| 0SRB01A | Replacement of Left Hip Joint with Metal Synthetic Substitute, Uncemented, Open Approach |
| 0SRB01Z | Replacement of Left Hip Joint with Metal Synthetic Substitute, Open Approach |
| 0SRB029 | Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SRB02A | Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SRB02Z | Replacement of Left Hip Joint with Metal on Polyethylene Synthetic Substitute, Open Approach |
| 0SRB039 | Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Cemented, Open Approach |
| 0SRB03A | Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Uncemented, Open Approach |
| 0SRB03Z | Replacement of Left Hip Joint with Ceramic Synthetic Substitute, Open Approach |
| 0SRB049 | Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SRB04A | Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SRB04Z | Replacement of Left Hip Joint with Ceramic on Polyethylene Synthetic Substitute, Open Approach |
Right Knee: 368 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0SRC069 | Replacement of Right Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SRC06A | Replacement of Right Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SRC06Z | Replacement of Right Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Open Approach |
| 0SRC07D | Replacement of Right Knee Joint with Autologous Tissue Substitute, Medial Meniscus, Open Approach |
| 0SRC07E | Replacement of Right Knee Joint with Autologous Tissue Substitute, Lateral Meniscus, Open Approach |
| 0SRC07Z | Replacement of Right Knee Joint with Autologous Tissue Substitute, Open Approach |
| 0SRC0J9 | Replacement of Right Knee Joint with Synthetic Substitute, Cemented, Open Approach |
| 0SRC0JA | Replacement of Right Knee Joint with Synthetic Substitute, Uncemented, Open Approach |
| 0SRC0JZ | Replacement of Right Knee Joint with Synthetic Substitute, Open Approach |
| 0SRC0KD | Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Medial Meniscus, Open Approach |
| 0SRC0KE | Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Lateral Meniscus, Open Approach |
| 0SRC0KZ | Replacement of Right Knee Joint with Nonautologous Tissue Substitute, Open Approach |
Left Knee: 368 ICD-10 codes drive assignment to this group; the first 12 are shown.
| ICD-10 code | Description |
|---|---|
| 0SRD069 | Replacement of Left Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Cemented, Open Approach |
| 0SRD06A | Replacement of Left Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Uncemented, Open Approach |
| 0SRD06Z | Replacement of Left Knee Joint with Oxidized Zirconium on Polyethylene Synthetic Substitute, Open Approach |
| 0SRD07D | Replacement of Left Knee Joint with Autologous Tissue Substitute, Medial Meniscus, Open Approach |
| 0SRD07E | Replacement of Left Knee Joint with Autologous Tissue Substitute, Lateral Meniscus, Open Approach |
| 0SRD07Z | Replacement of Left Knee Joint with Autologous Tissue Substitute, Open Approach |
| 0SRD0J9 | Replacement of Left Knee Joint with Synthetic Substitute, Cemented, Open Approach |
| 0SRD0JA | Replacement of Left Knee Joint with Synthetic Substitute, Uncemented, Open Approach |
| 0SRD0JZ | Replacement of Left Knee Joint with Synthetic Substitute, Open Approach |
| 0SRD0KD | Replacement of Left Knee Joint with Nonautologous Tissue Substitute, Medial Meniscus, Open Approach |
| 0SRD0KE | Replacement of Left Knee Joint with Nonautologous Tissue Substitute, Lateral Meniscus, Open Approach |
| 0SRD0KZ | Replacement of Left Knee Joint with Nonautologous Tissue Substitute, Open Approach |
Right Ankle: 5 ICD-10 codes drive assignment to this group.
| ICD-10 code | Description |
|---|---|
| 0SRF07Z | Replacement of Right Ankle Joint with Autologous Tissue Substitute, Open Approach |
| 0SRF0J9 | Replacement of Right Ankle Joint with Synthetic Substitute, Cemented, Open Approach |
| 0SRF0JA | Replacement of Right Ankle Joint with Synthetic Substitute, Uncemented, Open Approach |
| 0SRF0JZ | Replacement of Right Ankle Joint with Synthetic Substitute, Open Approach |
| 0SRF0KZ | Replacement of Right Ankle Joint with Nonautologous Tissue Substitute, Open Approach |
Left Ankle: 5 ICD-10 codes drive assignment to this group.
| ICD-10 code | Description |
|---|---|
| 0SRG07Z | Replacement of Left Ankle Joint with Autologous Tissue Substitute, Open Approach |
| 0SRG0J9 | Replacement of Left Ankle Joint with Synthetic Substitute, Cemented, Open Approach |
| 0SRG0JA | Replacement of Left Ankle Joint with Synthetic Substitute, Uncemented, Open Approach |
| 0SRG0JZ | Replacement of Left Ankle Joint with Synthetic Substitute, Open Approach |
| 0SRG0KZ | Replacement of Left Ankle Joint with Nonautologous Tissue Substitute, Open 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 461 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 461
What is MS-DRG 461?
MS-DRG 461 is "Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC", 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 461?
The FY2027 relative weight is 4.9710 (IPPS final rule Table 5, effective October 1, 2026). In FY2026 it was 5.5230, a change of -10.0%.
What is the average length of stay for DRG 461?
CMS reports a geometric mean length of stay of 6.2 days and an arithmetic mean of 8.3 days for FY2027. The geometric mean is used for transfer-payment calculations.
Which DRGs are in the same CC/MCC family as 461?
DRG 462 (Bilateral or Multiple Major Joint Procedures of Lower Extremity without MCC, weight 2.8530). The family's weights range from 2.8530 to 4.9710, so documented complications and comorbidities change payment materially.
What documentation supports the severity level of DRG 461?
DRG 461 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 461?
The v44 Definitions Manual lists 477 right hip codes and 477 left hip codes and 368 right knee codes and 368 left knee codes and 5 right ankle codes and 5 left ankle codes for this group. Examples from the right hip list: 0SR9019 (Replacement of Right Hip Joint with Metal Synthetic Substitute, Cemented, Open Approach); 0SR901A (Replacement of Right Hip Joint with Metal Synthetic Substitute, Uncemented, Open Approach); 0SR901Z (Replacement of Right Hip Joint with Metal Synthetic Substitute, Open Approach); 0SR9029 (Replacement of Right Hip Joint with Metal on Polyethylene Synthetic Substitute, Cemented, Open Approach).
Is DRG 461 a post-acute transfer DRG?
No. DRG 461 is not on the FY2027 post-acute care transfer list, so the transfer per-diem policy does not apply to it.
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.