Acute Myocardial Infarction, Expired without CC/MCC DRG Reimbursement

Summary & Overview

Acute Myocardial Infarction, Expired without CC/MCC: Inpatient Reimbursement Overview

DRG 285 addresses inpatient stays for patients who die from acute myocardial infarction without Major Complication or Comorbidity or Complication or Comorbidity, focusing on the clinical scenario of a fatal myocardial infarct. Proper grouping matters for inpatient reimbursement because it determines the Centers for Medicare & Medicaid Services prospective payment and aligns payment with documented clinical severity and resource use.

Acute Myocardial InfarctionDRG Acute Myocardial Infarction, Expired without CC/MCCDRG 285Diagnosis-Related GroupInpatient ReimbursementMedicareCardiologyCritical CareCardiovascular Procedures

DRG 285 Overview

DRG 285 covers inpatient hospitalizations for patients with acute myocardial infarction who expire during the admission and do not have a Major Complication or Comorbidity or a Complication or Comorbidity. This Diagnosis-Related Group captures cases where the primary clinical event is fatal acute myocardial infarction and resource use is influenced by end-of-life care, diagnostic evaluation, and any interventions attempted prior to death. It matters for Medicare payment because classification into this Diagnosis-Related Group determines the prospective payment and reflects clinical and coding documentation tied to mortality and resource consumption. Accurate assignment affects hospital reimbursement under Centers for Medicare & Medicaid Services inpatient prospective payment policies.

National Payment Rates

Across commercial payers the observed payment range runs from about $370 to $21K, with payer means spanning roughly $5.6K to $10K. The widest single-payer spread appears with Anthem (min $390 to max $21K). See the payer table and chart below for payer-specific quartiles and full distributions for Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna, and Anthem.

Mean Rates by Payer — National — DRG 285

The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment ($5.4k), average submitted covered charges ($30.7k), average Medicare payment ($3.8k), and total discharges (131).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

DRG 285 reimbursement means in Alaska range from $9.3K (Blue Cross Blue Shield and Anthem) up to $14K (Cigna), with Cigna driving the upper bound. This distribution shows a concentrated low-end around $9.3K and a single higher outlier at $14K. The table and chart below provide the payer-level breakdown and visual context.

Key Insights for Alaska

Highest payer: Cigna (mean $14K); Lowest payers: Blue Cross Blue Shield and Anthem (each mean $9.3K).
Cigna’s mean in Alaska (~$14K) is notably above the state’s other payers and exceeds the national BCBS/Cigna/Anthem medians, indicating a meaningful upward deviation from national central tendencies.

Clinical Trials

Acute-phase interventional trials evaluating timing and methods of reperfusion and supportive care in patients with fatal acute myocardial infarction: these studies focus on immediate hospital management strategies for patients presenting with ST-elevation or large non–ST-elevation myocardial infarction who are hemodynamically unstable and at highest short-term mortality risk. Investigators compare protocols for rapid coronary reperfusion, adjunctive antithrombotic strategies, and ICU-level supportive measures to determine impact on in-hospital survival and organ failure; results inform acute care pathways and resource allocation decisions for providers and payers caring for high-risk AMI patients.
Comparative effectiveness and prognostic cohort studies of comorbidity-driven care bundles in elderly or multimorbid AMI patients: these observational or pragmatic randomized studies examine how different inpatient care bundles (for example, protocols that integrate heart failure management, renal protection, and delirium prevention) affect short-term mortality and complications among older adults or those with significant comorbid conditions who experience AMI and die during hospitalization. These trials address which integrated approaches reduce length of stay, complications, and downstream costs, providing actionable evidence for clinicians and payers to optimize care for complex patients commonly grouped in this DRG.
Post-mortem and quality-of-care review studies linking prehospital and in-hospital processes to mortality outcomes for AMI patients: these investigations analyze registry, chart review, and system-level data to identify delays in symptom recognition, EMS response, door-to-treatment times, and in-hospital decision points associated with in-hospital death without major complications recorded. By characterizing preventable process failures and variation across hospitals, this research supports quality improvement programs and payer-driven performance incentives aimed at reducing preventable AMI deaths and aligning reimbursement and care pathways with best practices.

Peripheral Vascular Disorders with CC: Inpatient Reimbursement Overview

268-AORTIC-AND-HEART-ASSIST-PROCEDURES-EXCEPT-PULSATION-BALLOON-WITH-MCC

Aortic and Heart Assist Procedures Except Pulsation Balloon with MCC: Inpatient Reimbursement Overview

309-CARDIAC-ARRHYTHMIA-AND-CONDUCTION-DISORDERS-WITH-CC

Cardiac Arrhythmia and Conduction Disorders with CC: Inpatient Reimbursement Overview

359-PERCUTANEOUS-CORONARY-ATHERECTOMY-WITH-INTRALUMINAL-DEVICE-WITH-MCC

Percutaneous Coronary Atherectomy with Intraluminal Device with MCC: Inpatient Reimbursement Overview

303-ATHEROSCLEROSIS-WITHOUT-MCC

Atherosclerosis without MCC: Inpatient Reimbursement Overview

266-ENDOVASCULAR-CARDIAC-VALVE-REPLACEMENT-AND-SUPPLEMENT-PROCEDURES-WITH-MCC

Endovascular Cardiac Valve Replacement and Supplement Procedures with MCC: Inpatient Reimbursement Overview

270-OTHER-MAJOR-CARDIOVASCULAR-PROCEDURES-WITH-MCC

Other Major Cardiovascular Procedures with MCC: Inpatient Reimbursement Overview

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Other Major Cardiovascular Procedures with CC: Inpatient Reimbursement Overview

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Other Endovascular Cardiac Valve Procedures without MCC: Inpatient Reimbursement Overview

278-ULTRASOUND-ACCELERATED-AND-OTHER-THROMBOLYSIS-OF-PERIPHERAL-VASCULAR-STRUCTURES-WITH-MCC

Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCC: Inpatient Reimbursement Overview

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OpenPayer

Summary & Overview

Acute Myocardial Infarction, Expired without CC/MCC: Inpatient Reimbursement Overview

DRG 285 Overview

National Payment Rates

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes

Patient Population

State Payment Rates

Alaska Benchmarks

Key Insights for Alaska

Clinical Trials

Related Codes