MS-DRG 291: Heart Failure and Shock with MCC
ADHF + MCC. Very high volume DRG
Typical indications
- ADHF + AKI
- ADHF + sepsis
- Cardiogenic shock
Common denial patterns
- MCC clinical validation (AKI, sepsis)
- Inpatient necessity
Appeal angles
Document BNP, weight gain, oral diuretic failure, IV diuresis need, EF, troponin if ACS r/o.
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. 291 has relative weight 1.4632. 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 291?
Heart Failure and Shock with MCC. ADHF + MCC. Very high volume DRG.
What are typical indications?
ADHF + AKI; ADHF + sepsis; Cardiogenic shock.
Why are claims under this DRG denied?
MCC clinical validation (AKI, sepsis); Inpatient necessity.
How do I appeal?
Document BNP, weight gain, oral diuretic failure, IV diuresis need, EF, troponin if ACS r/o.
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