Healthcare Insights
Top 20 DRGs by highest readmission rates
In healthcare, diagnosis-related groups (DRGs) are a system used to classify inpatient hospital stays based on a patient’s diagnosis, procedures, age, sex, and other characteristics.
The DRG system has been adopted by Medicare and some health insurance companies to determine how much to pay for a patient’s hospital stay as a means to standardize hospital reimbursements while improving treatment efficiency.
While DRGs are often associated with billing, they also provide a useful lens into hospital performance. When certain DRGs consistently show higher readmission rates, it could indicate deeper challenges tied to patient complexity, discharge planning, and continuity of care.
Below, we used HospitalView and data from the Medicare Standard Analytical Files (SAF) to rank the top DRGs by volume at each hospital tracked in Definitive Healthcare’s database and their readmission rates. It’s important to note that certain types of hospitals, such as critical access hospitals and psychiatric hospitals, don’t track readmissions with CMS due to their specialties. For that reason, our list only includes short-term acute care hospitals with DRG activity.
| Rank | DRG code | Description | Readmission rate | Explore dataset |
|---|---|---|---|---|
| 1 | 871 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC | 23.73% | Explore |
| 2 | 291 | HEART FAILURE & SHOCK W MCC | 27.36% | Explore |
| 3 | 177 | RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC | 22.66% | Explore |
| 4 | 193 | SIMPLE PNEUMONIA & PLEURISY W MCC | 21.93% | Explore |
| 5 | 885 | PSYCHOSES | 25.91% | Explore |
| 6 | 392 | ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC | 17.94% | Explore |
| 7 | 872 | SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC | 18.29% | Explore |
| 8 | 690 | KIDNEY & URINARY TRACT INFECTIONS W/O MCC | 18.35% | Explore |
| 9 | 640 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC | 28.51% | Explore |
| 10 | 280 | ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC | 28.47% | Explore |
| 11 | 698 | OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC | 29.32% | Explore |
| 12 | 189 | PULMONARY EDEMA & RESPIRATORY FAILURE | 26.00% | Explore |
| 13 | 689 | KIDNEY & URINARY TRACT INFECTIONS W MCC | 22.00% | Explore |
| 14 | 853 | INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC | 27.87% | Explore |
| 15 | 683 | RENAL FAILURE W CC | 21.60% | Explore |
| 16 | 682 | RENAL FAILURE W MCC | 26.57% | Explore |
| 17 | 378 | G.I. HEMORRHAGE W CC | 19.26% | Explore |
| 18 | 641 | MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC | 19.49% | Explore |
| 19 | 312 | SYNCOPE & COLLAPSE | 15.86% | Explore |
| 20 | 64 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC | 19.77% | Explore |
Fig 1. Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Standard Analytical Files (SAF). Data accessed April 2026.
What are the top hospital DRG codes?
The top DRG code by volume for the 2024 calendar year was 871: septicemia or severe sepsis without mechanical ventilation with major complication or comorbidity. Sepsis is the result of a complication of an infection and can be life-threatening. It is a healthcare associated infection (HAI) and is considered to be among the most clinically complex and high-risk inpatient categories, as sepsis can rapidly impact multiple organ systems. It had a readmission rate of 23.73%.
In second place is DRG code 291: heart failure and shock with major complication or comorbidity. Heart failure is a chronic condition in which the heart can’t pump enough blood to meet the body’s need for blood and oxygen. It had a readmission rate of 27.36%.
DRG code 177, respiratory infections and inflammations with major complication or comorbidity is third place on our list. This category generally includes patients who are hospitalized for serious respiratory infections or inflammatory conditions such as pneumonia, bronchitis, or other lower respiratory tract infections. DRG 177 had a readmission rate of 22.66% in 2024.
From our list, the DRG code with the highest readmission rate is 698, which refers to other kidney and urinary tract diagnoses with major complication or comorbidity. This category includes patients who are admitted for kidney or urinary tract-related conditions that don’t fall into more specific categories. Its readmission rate is 29.32%.
Learn more
Healthcare Insights are developed with data from the Definitive Healthcare product portfolio and from CMS. Want even more insights? Read our analyses of the top DRGs by total diagnoses or start a free trial now and get access to the latest intelligence on hospitals, physicians, and other healthcare providers.
