Part 3: New ICD-10 Codes and IPPS Changes
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2020.
IPPS Changes Financial
On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
Acute care hospitals that report quality data and that are meaningful users of EHRs will receive approximately a 3.1% increase in Medicare operating rates. Calculation:
- Market basket update, plus 3.00%
- Productivity update, minus 0.40%
- 21st Century Cures Act adjustment, plus 0.50%
Hospitals that do not submit quality data would lose 1/4 of the market basket update (of 3.1% as above) and hospitals that are not meaningful users of EHRs will be subject to a 3/4 reduction of the market basket for FY 2020.
CMS is increasing the maximum add-on payment for new tech from 50% to 65% of estimated costs.
CMS is projecting that with the 3.1% increase and other changes to IPPS policies it will boost total IPPS payments by roughly $3.8 billion. Hospitals are required to report measures and meet the administrative requirements of the IQR program to avoid having their annual market basket update reduced by one quarter. The IQR also includes requirements to report electronic clinical quality measures (eCQMs) that align with the eCQM reporting requirements in the Promoting Interoperability Program. (Generated by provider’s E.H.R.)
CMS proposed three new measures for the IQR program, two of which are eCQMs, and one of which is a “hybrid” measure that combines electronic health record (EHR) data with Medicare claims data. CMS also proposes updates to eCQM submission requirements and discusses potential future new measures. We will not be discussing all of the quality measure changes and proposals, however a summary can be found here:
There were no new changes to the Post-Acute Care Transfer Policy for FY2020.
There were several changes involving DRGs. Below are the highlights.
- Peripheral ECMO: CMS is reassigning the following procedure codes describing peripheral ECMO procedures from their current MS-DRG assignments to Pre-MDC MS-DRG 003 (ECMO or Tracheostomy with Mechanical Ventilation >96 Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. Procedure) Titles of DRGs 207, 291, 296, 870 being revised. (Removing the “With ECMO”)
- 5A1522G, Extracorporeal Oxygenation, Membrane, Peripheral, Veno-arterial
- 5A1522H, Extracorporeal Oxygenation, Membrane, Peripheral Veno-venous
- Allogenic HCT procedures: CMS is reassigning four ICD-10-PCS codes for HCT (allogenic hematopoietic cell transplant) procedures specifying autologous cord blood stem sell as the donor source from MS-DRG 014 (RW 12.6338) to MS-DRGs 016 (RW 6.7587) and 017 (RW 4.3353)
- Affects procedure codes are 30230X0, 30233X0, 30240X0, 30243X0.
- Autologous HCT is not as costly as allogenic so allogenic will remain in DRG 014.
- CAR T Cell Therapy: CMS finalized the assignment of the following ICD-10-PCS codes to MS-DRG 16 for FY 2019 for CAR T Cell Therapy (Chimeric Antigen Receptor)
- XW033C3, Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into peripheral vein, percutaneous approach, new technology group 3
- XW043C3, Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy into central vein, percutaneous approach, new technology group 3
Pre-MDC MS-DRG 016 (Autologous Bone Marrow Transplant with CC/MCC or T-Cell
Immunotherapy) for FY 2019 and onward.
Allows coding of KYMRIAH™ and YESCARTA™ and new technology add-on payments.
Coder must be careful not to forget coding these procedure codes. These procedures were designated as non-OR procedures previously.
- 46 procedure codes were removed for “dilation of carotid artery” from MS-DRGs 034, 035, and 036 that describe procedures which (1) do not include an intraluminal device; (2) describe procedures performed on arteries other than a carotid; and (3) describe procedures performed on a vein.
- There are 48 procedure codes that include the qualifier term “bifurcation.” Therefore, these 48 procedure codes will be deleted effective October 1, 2019. The 48 remaining valid procedure codes that do not include the term “bifurcation” that we are removing from MS-DRGs 037, 038, and 039 will continue to be assigned to MS-DRGs 034, 035, and 036.
- Reassigning three ICD-10-CM diagnosis codes for pulmonary embolism with acute cor pulmonale as PDX from MS-DRG 176 (Pulmonary Embolism without MCC) to the higher severity level MS-DRG 175 (Pulmonary Embolism with MCC).
- I26.01 Septic pulmonary embolism with acute cor pulmonale
- I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
- I26.09 Other pulmonary embolism with acute cor pulmonale
- Cor Pulmonale is an alteration in the structure and function of the right ventricle of the heart caused by primary disorder such as pulmonary hypertension or embolism. Blockage in the pulmonary arteries supplying blood to the heart by pulmonary embolism causes increased work of right ventricle and right heart failure (cor pulmonale). Treat underlying cause.
- 02UG3JZ (Supplement mitral valve with synthetic substitute, percutaneous approach) (MitraClip®) and other valves.
- CMS reassigning cases reporting procedure codes describing an endovascular cardiac valve repair with implant from MS-DRGs 228 and 229 (Other cardiothoracic procedures, w and w/o MCC) to MS-DRGs 266 and 267 (Endovascular Cardiac Valve Replacement with and without MCC, respectively).
- For FY 2020, CMS is modifying the structure of MS-DRGs 266 and 267 by reassigning the procedure codes describing a transcatheter cardiac valve repair (supplement) procedure (MitraClip®) and to revise the title of these MS-DRGs.
- CMS is also creating two new MS-DRGs with a two-way severity level split for the remaining (non-replacement) (non-supplement) transcatheter cardiac valve procedures. These new MS-DRGs are 319 (Other Endovascular Cardiac Valve Procedures with MCC) and new MS-DRG 320 (Other Endovascular Cardiac Valve Procedures without MCC), which would also conform with the severity level split of MS-DRGs 266 and 267. We are proposing to reassign the procedure codes from their current MS-DRGs to the new MS-DRGs.
- CMS also corrected some previous errors involving pacemaker lead inserted into right atrium, and added omitted codes and deleted non applicable musculoskeletal codes from DRGs 485, 486, and 487 (Knee Procedure with Principal Diagnosis of Infection with MCC, with CC, and without CC/MCC, respectively) in MDC 8.
- CMS did an analysis of diagnosis code N13.6 (Pyonephrosis) and ICD-10-CM diagnosis code T83.192A (Other mechanical complication of indwelling ureteral stent, initial encounter) to see if it could be added to the list of principal diagnosis codes for MS-DRGs 691 and 692 (Urinary Stones with ESW Lithotripsy with CC/MCC and without CC/MCC, respectively) CMS did NOT approve.
- Analysts found the differences in payment were due to presence of MCC or CC and that there was no longer a clinical reason to subdivide MS-DRGS for urinary stones (MS-DRGs 591-694)
- Therefore, we are deleting MS-DRGs 691 and 692 and to revise the titles for MS-DRGs 693 and 694 from “Urinary Stones without ESW Lithotripsy with MCC” and “Urinary Stones without ESW Lithotripsy without MCC”, respectively to “Urinary Stones with MCC” and “Urinary Stones without MCC”, respectively.
OR to Non-OR and Vice Versa DRG Changes
Several changes were made that involved cases that grouped to DRGs 981, 982 and 983. The cases were changed out of those DRGs to DRGs within the proper MDC. They involved:
- Moving of GIST (gastrointestinal stromal tumor) with surgery to DRGS 326-328
- Moving of complications of peritoneal dialysis catheters (T85.6- – A) with procedure codes 0WHG03Z, 0WHG43Z, 0WPG03Z, 0WPG43Z, 0WWG03Z, 0WWG0JZ, 0WWG43Z, 0WWGMoving pr4JZ to DRGS 907-909.
- Moving codes describing open excision of sacrum, pelvic bones, and coccyx (0QB10ZZ, 0QB20ZZ, 0QB30ZZ, 0QBS0ZZ) with a PDX of pressure ulcers stage 3 and 4 to DRGs 579-581.
- Moving some procedure codes describing excision of lower extremity muscles and tendons (0KB-0ZZ) with diagnoses in MDC 10 (Endocrine, Nutritional and Metabolic Diseases and Disorders) to DRGs 622-624.
- Adding procedure code 0DH60UZ in MDC 1 to MS-DRGs 040, 041, and 042 (Periph/Cranial Nerve Syst Proc, W MCC, W CC, W/O CC/MCC.) and also with a principal diagnosis in MDC 10 to MS-DRGs 628, 629, and 630 (Other Endocrine, Nutrit & Metab O.R. Proc W MCC, W CC, W/O CC/MCC)
- Adding procedures describing reposition of basilic vein in CKD patients to DRGs 673-675.
- Adding code 0DTN0ZZ (Resection of sigmoid colon, open approach) to MS-DRGs 673, 674, and 675.
- Moving procedures for transfer of hip muscle to DRGs 573-575.
- Gastric Band complications with revision removal will now group to DRG 326, 327, 328 (Stomach, Esophageal & Duodenal proc W MCC, WCC, W/O CC/MCC)
- Added 06LB3DZ for occlusion of left renal vein with intraluminal device to DRGs 715-718 and 749-750
- Changed procedure code 0F9G30Z (Drainage of pancreas with drainage device, percutaneous approach) so it is not recognized as an O.R. procedure for purposes of MS-DRG assignment.
- Removal of all of the below as “OR Procedures:”
- All 13 bronchoalveolar lavage codes previously as OR procedures (root operation drainage 0B9-8Z-. This is a big change that needed to happen!
- Percutaneous drainage of pelvic cavity (0W9J3ZX)
- Percutaneous removal of drainage devices from the pancreas (0FPG30Z)
- Add percutaneous occlusion of gastric artery as an OR procedure (04L23DZ)
- Add 8 procedure codes that describe insertion of endobronchial valve procedures. (0BH – 8GZ) as OR Procedures to MS-DRGs 163, 164, 165 (Major Chest Procedures with MCC).
Several changes were made o the Medicare Code Editor (MCE). For example, maternity diagnoses age range was changed from 12 to 55 years to 9 to 64 years since pregnancies do occur at these ages. Several codes were added to the unacceptable PDX edit.
MCC/CC Severity Levels
Perhaps the biggest turn-around from the proposed rule was CMS’s decision to NOT change the many diagnoses they had listed to delete from the MCC list or CC list, or change from a MCC to CC. CMS had proposed to delete 153 diagnoses from the MCC list. After the proposed rule was released, “many commenters requested that the adoption of the changed be delayed in order to provide additional time to evaluate given the broad scope of the proposed changes.” Only the new codes for FY2020 were added. Coders and review tables 6I.1, 6I.2, 6J.1 and 6J.2 for these additions and deletions.
So there you have it for a brief summary of the IPPS FY2020 changes. Stay tuned….. In the last Part 4 of this series, the New Technology Add-On Payments (NTAP) will be reviewed in detail.
The information contained in this coding advice 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.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.