The FY 2020 IPPS proposed changes could bode well for many facilities.
There has been much discussion about the Centers for Medicare and Medicaid (CMS) Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020 proposed rule and its suggested changes. Good news can be found in the 1,824 pages of the proposed rule. The goal of this article is to discuss the Medicare Severity Diagnosis Related Groups (MS-DRGs) changes with a focus on the good.
The Good News
There are positives in the proposed MS-DRG changes. The movement of peripheral extracorporeal membrane oxygenation (ECMO) has a significant increase in relative weight values. The reassignment of I26.01 (Septic pulmonary embolism with acute cor pulmonale) and I26.02 (Saddle embolus of the pulmonary artery with acute cor pulmonale) from MS-DRG 176 to MS-DRG 175 raises the relative weight by 0.5465.
The addition of 02H60JZ (insertion of pacemaker lead into the right atrium) moves from designation of non-procedure code to procedure code and now will be assigned to surgical MS-DRGs 260-262. The movement of diagnosis codes that cover pyogenic arthritis, direct infection of a joint, and other bursopathies to MS-DRGs 485, 486, 487 is another positive shift in relative values. Neuromuscular scoliosis and secondary scoliosis/kyphosis undergo a shift in MS-DRG assignment after the diagnosis codes are moved from MS-DRGs 459 and 460 to MS-DRGs 456-458. This shift also separates all the possible severity levels within the MS-DRG rather than with MCC/CC or without MCC/CC. From Chapter 15 (Pregnancy, Childbirth, and Puerperium), the shift of assignment of O99.89 (Other specified diseases complicating pregnancy, childbirth, and puerperium) from postpartum diagnosis to antepartum diagnosis.
The Bright Spots
The seven previously mentioned proposed changes to the MS-DRG are the bright spots in the proposed rule. The remaining five adjustments are a negative change for the facility. 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 |
18.8862 |
|
Allogeneic Bone Marrow Transplant |
Reassign some transfusion codes Delete 128 clinically invalid transfusion codes from PCS |
014 |
11.9503 |
016 017 |
6.5394 4.3811 |
|
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 were missing) to MS-DRG 034, 035, 036 |
034 035 036 |
3.5998 2.2203 1.7260 |
037 038 039 |
3.5493 1.8411 1.1432 |
|
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 |
1.4455 |
|
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 |
7.1915 5.8481 4.2423 2.4576 |
|
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 |
3.7934 1.9996 1.6657 |
|
Knee Proc w/PDx of Infection |
Add M00.9, A18.02, M01.X61, Mo1.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 |
3.1672 2.2278 1.6989 |
|
Neuromuscular Scoliosis |
Move M41.40, M41.44, M41.45, M41.46, M41.47 |
459 460 |
6.3848 4.0375 |
456 457 458 |
9.2463 6.7416 5.3026 |
|
Secondary Scoliosis/Kyphosis |
Move M41.50, M41.54, M41.55, M41.56, M41.57, M40.10, M40.14, M40.15 Diagnosis codes for cervical spine with be removed from 456, 457, 458 |
459 460 |
6.3848 4.0375 |
456 457 458 |
9.2463 6.7416 5.3026 |
|
Extracorporeal Shockwave Lithotripsy |
Delete MS-DRGs 691, 692 Update titles for 693, 694 |
691 692 |
1.6242 1.1306 |
693 694 |
1.3888 0.7413 |
|
Other specified conditions affecting pregnancy, childbirth, and puerperium (O99.89) |
Re-classify as antepartum condition |
769 (w/OR) 776 (w/o OR) |
1.4579 0.6590 |
817 818 819 831 832 833 |
2.5562 1.4931 0.9431 1.2165 0.7608 0.5793 |
|
Abnormal finding on diagnostic imaging of other specified body structures (R93.89) |
Re-assign from MDC 5 to MDC 23 |
MDC 5 (215 – 320) |
12.8861 – 0.4825 |
MDC 23 (939 – 951) |
4.1724 – 0.5881 |
Other News: 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.
Unfortunately, there is mostly bad news for the shifts from these MS-DRGs. Out of the eleven proposed shifts from MS-DRGs 981-983 and 987-989, only one is a positive change for the facility. The gastric band procedures for complications/injuries which incorporate two additional ICD-10-PCS codes into MDC 6 (Diseases and Disorders of the Digestive System). The MS-DRGs 987 – 989 with relative weights that range from 3.3326 to 1.0407 will be shifted to MS-DRGs 326-328 with associated relative weights that range from 5.5899 to 1.6480. The remaining 10 topics result in downgrades in relative weights.
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 |
4.3007 2.1884 1.4243 |
|
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 |
3.2677 1.7514 1.2649 |
|
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 |
3.8833 2.0432 1.0923 |
|
Kidney Transplant |
Add kidney transplant codes to DRG 264 |
981 982 983 |
4.3705 2.4529 1.5691 |
264 |
3.2357 |
|
Insertion of Feeding Device |
Move 0DH60UZ from MDC 1 |
981 982 983 |
4.3705 2.4529 1.5691 |
040 041 042 |
4.1266 2.4494 1.8735 |
|
Insertion of Feeding Device |
Move 0DH60UZ from MDC 10 |
981 982 983 |
4.3705 2.4529 1.5691 |
628 629 630 |
4.3185 2.3904 1.4629 |
|
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 |
4.1551 2.3427 1.6330 |
|
Colon Resection with Fistula |
Add procedure code 0DTN0ZZ to MDC 11 |
981 982 983 |
4.3705 2.4529 1.5691 |
673 674 675 |
4.1551 2.3427 1.6330 |
|
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 |
3.2677 1.7514 1.2649 |
|
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 |
5.5899 2.7418 1.6480 |
|
Occlusion of Left Renal Vein |
Add procedure code 06LB3DZ to MDC 12 |
981 982 983 |
4.3705 2.4529 1.5691 |
715 716 717 718 |
2.3162 1.3945 1.8127 1.2112 |
|
Occlusion of Left Renal Vein |
Add procedure code 06LB3DZ to MDC 13 |
981 982 983 |
4.3705 2.4529 1.5691 |
749 750 |
2.7660 1.4815 |
In summary, there is some good news in the FY20 IPPS proposed rule. It is important to understand how these proposed changes will impact your facility. If you have an opinion regarding changes that are included in the proposed rule, you can comment. CMS is requesting comments regarding this proposal which are due by June 24, 2019.
The comments must reference CMS-1716-P and can be uploaded to http://www.regulations.gov or mailed to Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-1716-P, P.O. Box 8013, Baltimore, MD 21244-1850.
Programming Note:
Listen to Laurie Johnson report this story live today during Talk Ten Tuesday, 10-10:30 a.m. ET.
Resources:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-08330.pdf
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full
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