FY2021 Proposed Rule and Code Changes Highlights
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
MS-DRG Proposed Changes
CMS wants to create a new MS-DRG specifically for CAR-T therapies, MS-DRG 018 (Chimeric Antigen Receptor T-cell Immunotherapy). CAR T-cell therapies will no longer be eligible for new technology add on payments for FY2021. Procedure codes XW033C3 and XW043C3 are involved.
There is also a proposal to create new MS-DRGS 521 and 522, Hip replacement with PDX of hip fx with and without MCC.
There is another proposal to create Pre-MDC MS-DRGs for cases with hemodialysis done with pancreas/kidney transplant along with wo new MS-DRGs for kidney transplant with hemodialysis.
There are also proposed changes to reassign several procedures in existing MS-DRGs to other DRGS. They involve carotid artery stent procedures, epilepsy with neurostimulator, TMJ replacements with two new base DRGs, left atrial appendage closure (LAAC), insertion of cardiac contractility modulation devices.
ICD-10-CM Proposed Diagnosis Code Changes
There are 595 proposed changes for FY2021: 490 new codes, 47 revised codes and 58 deleted codes. Below are just the highlights.
ICD-10-CM proposed code additions include:
- Additional D57 codes for more specified sickle-cell anemia
- Additional codes for D59.1- autoimmune hemolytic anemias
- D89 codes for cytokine release syndrome
- Many new codes related to drug use and abuse (including alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, other psychoactive) with F10-F15 and F19 codes. (i.e., F10.120, Alcohol ABUSE with withdrawal, uncomplicated)
- New G97.- codes for intracranial hypotension
- Expanded list of H18 corneal dystrophy codes
- Expanded M05, M06, M08, and M19 codes for both adult and juvenile rheumatoid arthritis and osteoarthritis
- New M26.- codes for arthritis of temporomandibular joint
- Expansion of N18.3- CKD stage 3a and stage 3b codes
- Expanded R51 codes relating to headaches
- Additional S20 codes for injuries to the thorax
- Expanded T40 codes for poisoning, underdosing, and adverse effects of fentanyl, tramadol, and other synthetic narcotics
- Roughly 120 new V00-V06 codes for electric scooter and other micro-mobility pedestrian conveyance injuries
ICD-10-CM proposed code deletions include:
- Some H18 corneal dystrophy codes because of the proposed expanded additions
- R51 because of proposed specified headache additions
- Some T40 codes for poisoning due to proposed specified additions such as Tramadol and synthetic narcotics
ICD-10-CM proposed revised codes include:
There are several revised titles
- Z68 codes relating to both adult and pediatric body mass index
- Allergy status Z88 codes
Proposed MCC and CC Changes
Proposed MCC list changes include:
- Addition of the proposed D57 codes for sickle cell anemia
- Addition of U07.1 for COVID-19, which was already implemented on April 1, 2020
- Addition of proposed P91.- neonatal cerebral infarction codes
- Deletion of A84.8 for other tick-borne viral encephalitis, which was also a proposed ICD-10-CM deletion
Proposed CC list changes include:
- Additions of proposed B60.- Babesiosis codes
- Addition of the proposed F10-F15 and F19 codes related to drug use and abuse
- Addition of the proposed T86 codes related to corneal transplants
- Additions the proposed M80.- of age related and other osteoporosis with pathological fracture
- Deletions of proposed deleted T86 codes being replaced by more specified codes for corneal transplant complications
ICD-10-PCS Proposed Procedure Code Changes
- Many procedure codes were added to 02F, 03F and 04F with the addition of root operation “Fragmentation” to heart and great vessels, upper and lower arteries and veins body systems. One example is 02FS3Z0, Fragmentation of right pulmonary vein, percutaneous approach, ultrasonic
- Addition of drainage of pelvic cavity codes. One example is 0W9J70Z, Drainage of pelvic cavity with drainage device, via natural or artificial opening approach
- Addition of other imaging of bile ducts with fluorescing agent, indocyanine green dye and other. One example is BF532ZZ, other imaging of gallbladder and bile ducts using fluorescing agent
- Addition of Low does rate (LDR) brachytherapy codes in section D
- New codes for introduction of Brexanolone, Nerinitide, Esketamine Hydrochloride and Eladocagene exuparvovec
HIA will have online education sessions regarding the new codes and IPPS changes this fall.
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
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With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
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The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
In response to the recent occurrences of vaping related disorders and in consultation with the World Health Organization (WHO) Framework Convention on Tobacco Control, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) was convened to discuss a diagnosis code for vaping related illness for immediate use.
We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #3 DRG 190—Chronic obstructive pulmonary disease with MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #4 is DRG 193—Simple pneumonia & pleurisy with MCC.
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #5 DRG with the most recommendations during HIA reviews : DRG 853—Infectious & Parasitic diseases with O.R. procedure with MCC
Pivotal moments in the Health Information Management field include the implementation of ICD-10, CPT Coding Changes, Acute care changes, profee changes, recovery audit contractor implementation, new ransomware challenges, Meaningful use and much more.