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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Circulatory SystemDRG 304-hypertension-with-mcc
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    Hypertension with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    DRG 304 addresses inpatient admissions for hypertension accompanied by a Major Complication or Comorbidity, reflecting increased clinical complexity and resource needs. Correct grouping impacts inpatient reimbursement under Medicare because payment is adjusted based on severity levels captured by the Diagnosis-Related Group.

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    DRG 304 Overview

    DRG 304—Hypertension with Major Complication or Comorbidity—covers inpatient stays where primary or secondary hypertension is present alongside one or more Major Complication or Comorbidity conditions that increase resource use and clinical complexity. This Diagnosis-Related Group captures admissions requiring intensified monitoring, additional diagnostic workup, or treatment for severe hypertensive complications such as hypertensive crisis with end-organ effects or acute cardiovascular events. It matters for Medicare payment because classification into DRG 304 affects relative reimbursement levels tied to case severity and expected resource consumption. Accurate documentation and coding of the hypertension diagnosis and any Major Complication or Comorbidity are essential for correct grouping and payment assignment.

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    Clinical Trials

    • Acute in-hospital management trials evaluating protocols to rapidly control severe or malignant hypertension in patients with end-organ complications: these studies enroll hospitalized adults with very high blood pressure and major comorbidities (for example acute kidney injury, heart failure exacerbation, or hypertensive encephalopathy) to compare blood-pressure-lowering strategies, medication titration algorithms, and monitoring approaches. The objective is to identify approaches that safely reduce acute complications and length of stay without increasing adverse events; results inform hospital critical care pathways and short-term resource use relevant to inpatient reimbursement.
    • Comparative effectiveness and multimorbidity-focused studies testing blood pressure control strategies in medically complex patients with multiple chronic conditions: these trials or pragmatic studies recruit older adults or patients with significant comorbidity burden (chronic kidney disease, diabetes, heart disease) to compare different outpatient intensities of antihypertensive regimens, coordination of care models, or medication deprescribing approaches. They address real-world effectiveness, readmission risk, and medication-related harms, producing evidence that influences discharge planning, care management programs, and payer decisions about care bundles and post-discharge services.
    • Post-discharge outcomes and transitional care interventions assessing readmission reduction and long-term blood pressure control: these studies focus on the period after hospital discharge for patients admitted with hypertension and major complications, testing interventions such as enhanced discharge education, home blood pressure monitoring with remote follow-up, and care coordination with primary care or specialty clinics. The goal is to lower 30- and 90-day readmissions, improve adherence and control, and reduce downstream costs; findings are valuable to hospitals and payers designing transitional care reimbursement, quality metrics, and value-based payment models.

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    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with MCC: Inpatient Reimbursement Overview

    217-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    218-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITH-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

    219-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures with MCC: Inpatient Reimbursement Overview

    220-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITH-CC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with CC: Inpatient Reimbursement Overview

    221-CARDIAC-VALVE-AND-OTHER-MAJOR-CARDIOTHORACIC-PROCEDURES-WITHOUT-CARDIAC-CATHETERIZATION-WITHOUT-CC-MCC

    Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization without CC/MCC: Inpatient Reimbursement Overview

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    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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