CMS Publishes MS-DRG Information for COVID-19 and Relaxes Other Regulations

Latest information comes in the wake of the coronavirus pandemic.

The Centers for Medicare & Medicaid Services (CMS) has published Medicare Severity Diagnosis Related Group (MS-DRG) information related to COVID-19, effective April 1, 2020. The diagnosis will be a Major Complication Comorbidity (MCC), and grouping will be dependent on the Major Diagnostic Category (MDC).

This information is found on the Medicare website, under the Acute Inpatient PPS provider tab, accessible by selecting the MS-DRG Classifications and Software listing. The resource link is also found under “Resources” at the end of the article.

Medicaid waivers have been approved for the following 11 states: Alabama, Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, and Virginia. The waivers provide relief regarding prior authorization, provider enrollment requirements, certain nursing home pre-admission reviews, and reimbursement to providers for care delivered in alternative settings due to facility evacuations. Commercial and Medicare Advantage payors would have to be contacted to determine if they are adopting the same waivers.

CMS has also announced relief in the form of its Quality Payment Program. It has granted exceptions from reporting requirements and extensions with respect to upcoming measure reporting and data submission. The 2019 data submission deadline has been extended from March 31 to April 30 for the Merit-Based Incentive Payment System (MIPS). For Accountable Care Organizations (ACOs), MIPS-eligible clinicians who have not submitted data by April 30 will qualify for automatic extreme and uncontrollable circumstances, and will receive neutral payment adjustment for the 2021 MIPS payment year. CMS is continuing to evaluate options for data submission for 2020.

The Coordination and Maintenance Committee Meeting was held virtually for the first time on March 17-18. The biggest announcement was the movement of the effective date for the COVID-19 code (U07.1) from Oct. 1, 2020 to April 1, 2020. This news impacts the encoder vendors as they incorporate the diagnosis and MS-DRG information into their products. The COVID-19 and Electronic Vaping Associated Lung Injury (EVALI) cases with dates of service/discharge of April 1, 2020 should be held until the April 2020 product update has been installed. By pending the cases until the update installation, the claims will be correctly coded when the claims drop. The diagnosis code (U07.0) for EVALI was announced in January 2020, effective April 1. 

The procedure portion of the Coordination and Maintenance Committee Meeting was held on Tuesday, March 17, and was filled with proposals for administration of various medications. Concerns were voiced regarding the inclusion of specific medications in the classification.

The comments regarding the diagnosis and procedures may be submitted via email. The email address for procedures is ICDProcedureCodeRequest@cms.hhs.gov. Comments on diagnosis proposals may be sent to nchsicd10CM@cdc.gov. The comments must be received by May 18. The final codes for the Oct. 1, 2020 effective date will be published in June 2020.  

The next Coordination and Maintenance Committee Meeting is tentatively scheduled for Sept. 8-9, 2020. The deadline to submit topics for discussion is June 12. 

Watching or participating in the Coordination and Maintenance Committee Meeting is a great opportunity for free continuing education credits from the American Health Information Management Association (AHIMA) and/or AAPC. Contact AHIMA or AAPC regarding information needed to support the continuing education credits. 

For all things that are related to COVID-19, CMS has established a dedicated web page accessible at  https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page. This page contains coding advice, updates to regulations, and pricing information.

Programming Note: Listen to Laurie Johnson’s live reporting this morning on Talk Ten Tuesdays, 10-10:30 a.m. EST.