DRG 292 Overview

DRG 292 covers hospital admissions for heart failure and shock when a Complication or Comorbidity is present. This grouping includes patients with acute decompensated heart failure, cardiogenic shock with an associated Complication or Comorbidity, and related treatments such as diuresis, inotropic support, or hemodynamic monitoring. It matters for Medicare payment because the presence of Complications or Comorbidities increases resource use and drives higher Diagnosis-Related Group relative weights used in inpatient reimbursement. Accurate coding of the principal diagnosis and associated Complication or Comorbidity is essential for correct Medicare Severity Diagnosis-Related Group assignment.

Payer rates for DRG 292 range from about $8.5K (BCBS mean) up to $15K (Aetna mean), with Anthem and Cigna clustering near $13–14K; the widest mean spread between payers is roughly $6.5K. See the table and chart below for payer-specific percentiles and distributional detail. Payer variability is visible across the 25th–75th percentiles in the accompanying visuals.

The CMS 2023 data reflect national Medicare fee-for-service inpatient payments reported under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 292. Values summarize national Medicare payments and volumes for the reporting year.

• Acute hemodynamic intervention trials: randomized or controlled studies testing short-term interventions delivered during the hospitalization for heart failure or cardiogenic shock (for example, novel inotropes, vasodilators, or mechanical circulatory support strategies) targeted to patients with decompensated heart failure and objective evidence of hypoperfusion or congestion. These trials enroll patients during the index inpatient stay and measure time‑to‑stabilization, organ perfusion markers, and in‑hospital mortality and complications. Results inform hospital-level treatment algorithms, affect resource use in the acute care episode, and are directly relevant to payers because they can change lengths of stay, ICU utilization, and costs associated with high-acuity admissions in this DRG.
• Comparative effectiveness and management strategy studies: pragmatic randomized or observational studies comparing guideline-directed medical therapy pathways, diuretic strategies (e.g., bolus versus continuous infusion, high‑dose versus stepped dosing), or multidisciplinary care bundles for patients admitted with heart failure and a complication or comorbidity (the CC in this DRG). These studies commonly enroll heterogeneous inpatient populations including older adults with renal dysfunction, diabetes, or pulmonary disease, and evaluate outcomes such as readmission, in‑hospital adverse events, and transitions to outpatient care. Findings are important to clinicians and hospital administrators for optimizing inpatient protocols and to payers for identifying approaches that reduce avoidable rehospitalization and total cost of care across the episode.
• Post-discharge outcomes and transitional-care trials: randomized trials and prospective cohorts testing discharge planning interventions, early post-discharge follow-up, telemonitoring, or disease‑management programs specifically for patients recently hospitalized with heart failure or shock who have at least one complicating condition. These studies focus on 30‑ to 180‑day readmission rates, medication adherence, mortality, and patient‑reported outcomes in a high‑risk subgroup that often drives readmission metrics and bundled payment performance. Evidence from these trials guides investments in transitional-care teams and remote monitoring services that can improve quality metrics and reduce downstream costs for payers managing beneficiaries coded to this DRG.