Renal Failure with MCC DRG — Reimbursement & Medicare

Summary & Overview

Renal Failure with MCC: Inpatient Reimbursement Overview

DRG 682 encompasses inpatient renal failure cases with a Major Complication or Comorbidity, covering admissions where kidney dysfunction is accompanied by significant additional diagnoses that raise clinical complexity. This Diagnosis-Related Group matters for inpatient reimbursement because the presence of a Major Complication or Comorbidity increases expected resource use and therefore influences Centers for Medicare & Medicaid Services payment classification.

Renal Failure with Major Complication or ComorbidityDRG Renal Failure with MCCDRG 682Diagnosis-Related GroupInpatient ReimbursementMedicareNephrologyDialysisCritical Care

DRG 682 Overview

DRG 682 covers inpatient admissions for renal failure with Major Complication or Comorbidity and includes acute or chronic kidney failure when accompanied by significant additional diagnoses that increase resource use. This Diagnosis-Related Group is clinically focused on patients requiring intensified medical management, potential dialysis, and close monitoring for metabolic and fluid-electrolyte disturbances. It matters for Centers for Medicare & Medicaid Services payment because the presence of a Major Complication or Comorbidity increases expected resource consumption and affects reimbursement relative to lower severity categories. Accurate coding of renal failure and coexisting major conditions determines the appropriate Medicare inpatient payment classification.

National Payment Rates

Payer rates in the table range from about $7.4K to $55K across payers, with the widest spread observed between Anthem (max $55K) and BCBS (min $370 in the dataset), reflecting substantial variability by payer. See the table and chart below for payer-specific quartiles and medians. Payors shown include Cigna, Aetna, Blue Cross Blue Shield, and Anthem.

Mean Rates by Payer — National — DRG 682

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 ($13.3k), average submitted covered charges ($62.7k), average Medicare payment amount ($11.1k), and total discharges (80.2k).

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s DRG 682 benchmarks show a tight low-end cluster with Blue Cross Blue Shield and Anthem both at $23K, while Cigna’s mean sits notably higher at $36K, giving a state payer range from $23K to $36K. This represents a substantial deviation from the national context where medians and means for comparable payers are generally lower; see the table and chart below for payer-level detail and distribution.

Key Insights for Alaska

Blue Cross Blue Shield pays the lowest benchmark at $23K while Cigna pays the highest at $36K, representing the state range.
Anthem aligns with Blue Cross Blue Shield at $23K, creating a pronounced grouping at the low end compared with Cigna’s higher mean.
The state’s highest mean ($36K for Cigna) exceeds national BCBS/Aetna/Cigna averages shown in the national context, indicating a meaningful upward deviation for that payer in Alaska.

Clinical Trials

Acute renal replacement therapy trials: Interventional studies evaluating timing, modality (continuous vs intermittent), and dosing of renal replacement therapy for patients hospitalized with acute renal failure and major complications (e.g., hemodynamic instability, severe metabolic derangements, or multiorgan failure). These trials enroll critically ill inpatients with renal failure and major complications to determine whether earlier initiation, specific dialysis modalities, or intensity of clearance improves short-term survival, organ support needs, and length of ICU/hospital stay. Results directly inform inpatient protocols, resource allocation, and reimbursement considerations because choices around modality and timing drive intensive care utilization and costs for this high-acuity DRG.
Comparative effectiveness and comorbidity management studies: Observational cohorts or pragmatic randomized studies comparing strategies to manage common MCCs that accompany renal failure—such as heart failure, sepsis, or uncontrolled diabetes—during the index hospitalization. These studies focus on adult inpatients with renal failure plus one or more major comorbid conditions, testing integrated care pathways, medication adjustment algorithms, or monitoring strategies to reduce complications like fluid overload, electrolyte disturbances, or medication toxicity. Findings are relevant to clinicians and payers because better comorbidity management can shorten hospital stays, reduce readmissions, and influence bundled-payment models for complex renal failure cases.
Post-discharge outcome and transitional care studies: Prospective cohort studies and interventional trials assessing post-discharge modalities like early nephrology follow-up, home-based dialysis initiation programs, and care-coordination interventions for patients discharged after an admission for renal failure with MCC. These studies enroll survivors of high-acuity hospitalizations who are at high risk for readmission, progression to chronic dialysis, or mortality, measuring outcomes such as 30- and 90-day readmission rates, time to chronic kidney replacement therapy, functional status, and health-care utilization. This research informs discharge planning, outpatient resource prioritization, and payer strategies to reduce avoidable downstream costs associated with this resource-intensive DRG.

Kidney Transplant with Hemodialysis without MCC: Inpatient Reimbursement Overview

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Other Kidney and Urinary Tract Diagnoses without CC/MCC: Inpatient Reimbursement Overview

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Urinary Stones without MCC: Inpatient Reimbursement Overview

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Minor Bladder Procedures with MCC: Inpatient Reimbursement Overview

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Major Bladder Procedures with CC: Inpatient Reimbursement Overview

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Kidney and Urinary Tract Infections with MCC: Inpatient Reimbursement Overview

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Kidney and Ureter Procedures for Neoplasm without CC/MCC: Inpatient Reimbursement Overview

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Kidney Transplant with Hemodialysis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

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Kidney and Urinary Tract Infections without MCC: Inpatient Reimbursement Overview

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Kidney Transplant: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$13K	$63K	$11K	80K