MS-DRG 291: HEART FAILURE AND SHOCK WITH MCC
MS-DRG 291 is heart failure and shock with mcc, in MDC 05 (a medical DRG), at the with-MCC (major complication or comorbidity) level. Its FY2027 relative weight is 1.2685, so a case here pays more than the average Medicare inpatient stay (weight 1.0), with a geometric mean length of stay of 3.80 days. 29 ICD-10-CM principal diagnoses group into MS-DRGs 291–293 under the CMS definitions manual; the most-searched are listed below.
FY2027 payment factors
- Relative weight
- 1.2685
- Geometric mean LOS
- 3.80
- Arithmetic mean LOS
- 4.90
- Post-acute transfer
- Yes
This DRG is subject to the post-acute care transfer policy: a discharge to a qualifying setting below the mean length of stay is paid per diem rather than in full.
Principal diagnoses that group to MS-DRGs 291–293
From the CMS MS-DRG definitions manual’s principal-diagnosis index: 29 ICD-10-CM codes route here, and the CC/MCC status of the secondary diagnoses decides which of 291–293 the case lands in. The 24 most-searched:
- I50.9Heart failure, unspecified
- I13.0Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
- I11.0Hypertensive heart disease with heart failure
- I50.22Chronic systolic (congestive) heart failure
- I50.32Chronic diastolic (congestive) heart failure
- I13.2Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
- I50.20Unspecified systolic (congestive) heart failure
- I50.33Acute on chronic diastolic (congestive) heart failure
- I50.1Left ventricular failure, unspecified
- I50.23Acute on chronic systolic (congestive) heart failure
- I50.30Unspecified diastolic (congestive) heart failure
- I50.42Chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.21Acute systolic (congestive) heart failure
- I50.43Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.31Acute diastolic (congestive) heart failure
- I50.40Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
- I50.84End stage heart failure
- R57.0Cardiogenic shock
- R57.9Shock, unspecified
- I50.41Acute combined systolic (congestive) and diastolic (congestive) heart failure
- I50.89Other heart failure
- I09.81Rheumatic heart failure
- I50.82Biventricular heart failure
- I50.83High output heart failure
5 more codes group here. Open any code above for its full hierarchy, or check a whole claim in the free DRG calculator.
The severity splits
Same base DRG, split by whether a secondary diagnosis is a CC or MCC. The last column is the weight change from MS-DRG 291.
| 291 | HEART FAILURE AND SHOCK WITH MCC | 1.2685 | |
| 292 | HEART FAILURE AND SHOCK WITH CC | 0.8616 | -0.4069 |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | 0.5462 | -0.7223 |
Choosing the principal diagnosis: Hypertension ICD-10 codes.
All FY2027 MS-DRGs · MDC 05