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.

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.

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).

• 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.