Updated on: August 19, 2019

Surprising Changes in Inpatient Prospective Payment System Final Rule FY20

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Original story posted on: August 6, 2019

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Anticipated changes in the CC/MCC designations were delayed.

 EDITOR’S NOTE: Senior healthcare consultant Laurie Johnson reported this story live during Aug. 6 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting.

The Centers for Medicare and Medicaid (CMS) Inpatient Prospective Payment System (IPPS) FY20 Final Rule was released on August 2, 2019.    There were some anticipated changes that were a no-show in the 2,273 pages of the final rule that can be found.   This article discusses the Medicare Severity Diagnosis Related Groups (MS-DRGs) changes with a focus on the overall changes.

 

The CC/MCC Re-assignment

The anticipated changes in the CC/MCC designations were delayed. CMS received many comments regarding the suggested 1,492 changes in the CC/MCC designations that appeared in Proposed Rule.    Due to the increased comments, CMS decided to make some minor changes to the CC/MCC designations and review the topic for FY21.  

The non-CC to CC changes that were finalized include eighteen codes that appear in the Z16 category which covers resistance to various drugs. The Social Determinant of Health code Z59.0 (Homelessness) is still designated as non-CC. There was no additional information on the Social Determinants of Health in this Final Rule.

There appear to be 14,598 CCs and 3,249 MCCs for FY20 including the CC/MCC designations for the new diagnosis codes.   

The MS-DRG Changes

The overall relative values for FY20 have increased over the relative values for FY19. There are seven suggested MS-DRG changes that increase over FY19. The table below provides more detail regarding the shifts and specific MS-DRGs with the associated relative weights by topic. 

Topic

Actions

Original MS-DRG

FY19 RW

New MS-DRG

FY20

RW

Peripheral ECMO

Reassign peripheral ECMO to MS-DRG 003

Retitle MS-DRGs 207, 291, 296, and 870

207

291

296

870

5.5965

1.3454

1.5355

6.2953

003

18.9539

Allogeneic Bone Marrow Transplant

Reassign some transfusion codes

Delete 128 clinically invalid transfusion codes from PCS

014

11.9503

016

017

6.8852

4.4474

Carotid Artery Stents

Remove 46 PCS codes (carotid artery w/o stent or other vessels) from MS-DRG 034, 035, 036

Remove 96 codes (dilation carotid artery w/stent) from MS-DRGs 037, 038, 039

Move 6 proc code (dilation of carotid artery w/stent that was missing) to MS-DRG 034, 035, 036

034

035

036

3.5998

2.2203

1.7260

037

038

039

3.2433

1.6752

1.1313

Pulmonary Embolism

Re-assign secondary diagnosis of I26.01, I26.02, I26.09

Re-title MS-DRG “Pulmonary Embolism w/MCC or Acute Cor Pulmonale”

176

0.8990

175

1.4444

Transcatheter Mitral Valve Repair w/Implant

Move endovascular supplement procedures.

Create new MS-DRGs for endovascular non-supplement procedures.

216

217

218

219

220

221

228

229

273

274

10.2194

6.9849

5.5351

7.6916

5.2053

4.6074

6.5762

4.6484

3.6525

2.9783

266

267

319

320

7.1214

5.6756

4.1007

2.3477

Revision of Pacemaker Lead

Add 02H60JZ as non-procedure that impacts DRG assignment

260

261

262

3.6915

1.9918

1.6309

260

261

262

3.6996

1.9485

1.6776

Knee Proc w/PDx of Infection

Add A54.42, M00.9, A18.02, M01.X61, M01.X62, M01.X69, M71.061, M71.062, M71.069, M71.161, M71.162, M71.169

Remove several diagnoses from 485, 486, 487

548

549

550

2.0672

1.2442

0.9238

485

486

487

3.2790

2.1506

1.6072

Neuromuscular Scoliosis

Move M41.40, M41.44, M41.45, M41.46, M41.47

459

460

6.3848

4.0375

456

457

458

9.0812

6.5133

4.6939

Secondary Scoliosis/Kyphosis

Move M41.50, M41.54, M41.55, M41.56, M41.57, M40.10, M40.14, M40.15

34 Diagnosis codes for the cervical spine with being removed from 456, 457, 458

459

460

6.3848

4.0375

456

457

458

9.0812

6.5133

4.6939

Extracorporeal Shockwave Lithotripsy

Delete MS-DRGs 691, 692

Update titles for 693, 694

691

692

1.6242

1.1306

693

694

1.1723

0.6794

Other specified conditions affecting pregnancy, childbirth, and the puerperium (O99.89)

Re-classify as an antepartum condition

769 (w/OR)

776 (w/o OR)

1.4579

0.6590

817

818

819

831

832

833

0.7979

5.7167

2.2323

0.5321

5.8425

2.0282

Factors Influencing Health Status & Other Contacts with Health Services (R93.89)

Re-assign from MDC 5 to MDC 23

MDC 5

302

303

1.0695

0.6655

MDC 23

947

948)

1.0889

0.7409

Diagnostic Imaging of Male Anatomy

Move R93.811, R93.812, R93.819

302

303

1.0695

0.6655

729

730

2.1919

1.3742

 

 Changes to MS-DRGs 981 – 983 and 987 – 989

CMS routinely reviews the diagnosis and procedure codes that are grouping to the MS-DRGs 981-983 and 987 – 989.    These MS-DRGs cover the diagnosis and procedure mismatches.    The goal of the annual review is to reduce the number of situations that are assigned to these MS-DRGs.     

The following table displays the topics that are covered in the MS-DRGs 981 – 983 and 987-989.    Included in the table are a short description of the change, and the MS-DRGs assigned in FY19 with associated relative weight is compared to the proposed MS-DRG assigned in FY20 with the associated proposed relative weight.

 

Topic

Actions

Original MS-DRG

FY19 RW

FY20 MS-DRG

FY20 RW

Gastrointestinal Stromal Tumor (GIST) with stomach and/or small intestine excision

Move diagnosis codes to MDC 6

981

982

983

4.3705

2.4529

1.5691

326

327

328

5.5899

2.7418

1.6480

Peritoneal Dialysis Catheters

Add procedure codes for insertion, removal, or revision of peritoneal dialysis catheter to MDC 21

981

982

983

4.3705

2.4529

1.5691

907

908

909

1.3187

1.4763

0.8617

Bone Excision with Pressure Ulcers

Add procedure codes for excision of sacrum, pelvic bones, and coccyx to MS-DRGs 579, 580, 581

981

982

983

4.3705

2.4529

1.5691

579

580

581

2.9861

1.6087

1.2548

Lower Extremity Muscle & Tendon Excision

Add procedure codes for excision of muscle and tendon to DRGs 622, 623, 624

981

982

983

4.3705

2.4529

1.5691

622

623

624

3.7755

1.9526

1.1020

Insertion of Feeding Device

Move 0DH60UZ from MDC 1

981

982

983

4.3705

2.4529

1.5691

040

041

042

3.9404

2.3715

1.8483

Insertion of Feeding Device

Move 0DH60UZ from MDC 10

981

982

983

4.3705

2.4529

1.5691

628

629

630

3.6893

2.3228

1.4488

Basilic Vein Reposition in Chronic Kidney Disease

Add procedure codes to MDC 11

981

982

983

4.3705

2.4529

1.5691

673

674

675

3.5746

2.4442

1.6320

Colon Resection with Fistula

Add procedure code 0DTN0ZZ to MDC 11

981

982

983

4.3705

2.4529

1.5691

673

674

675

3.5746

2.4442

1.6320

Finger Cellulitis

Add procedure codes for phalanx excision or resection to MDC 9

981

982

983

4.3705

2.4529

1.5691

579

580

581

2.9861

1.6087

1.2548

Gastric Band Procedures for Complications/ Infections

Add procedure code 0DW64CZ and 0DP64CZ to MDC 6

987

988

989

3.3326

1.6931

1.0407

326

327

328

5.2708

2.5729

1.5750

Occlusion of Left Renal Vein

Add procedure code 06LB3DZ to MDC 12

981

982

983

4.3705

2.4529

1.5691

715

716

717

1.7643

1.2194

1.8049

Occlusion of Left Renal Vein

Add procedure code 06LB3DZ to MDC 13

981

982

983

4.3705

2.4529

1.5691

749

750

1.7619

1.0238

Peritoneal Dialysis Catheters

Move procedures codes for removal, revision, and insertion of peritoneal dialysis catheters

981

982

983

4.3705

2.4529

1.5691

907

908

909

1.3187

1.4763

0.8617

In summary, comments on the Proposed Rule made a big difference in the Final Rule.   The comments were read and made a difference.   CMS has tabled many of the CC/MCC designation changes. Additional feedback regarding any suggested changes for IPPS FY21 must be submitted by Nov. 1, 2019.


Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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