Expansion of new ICD-10 codes has slowed.

The 2019 Inpatient Prospective Payment System proposed rule covers many Medicare Severity Diagnosis-Related Groups (MS-DRGs) changes, in addition to changes to the Value-Based Purchasing (VBP), Hospital-Acquired Conditions (HACs), and Hospital Readmission Reduction program, as well as the post-acute care transfer policy.

The length of this year’s proposed rule is 1,883 pages, which is indicative of the amount of information provided. This article will focus on the suggested changes to MS-DRGs.

Pre-MDC: There is concern regarding the accurate coding of the left ventricular assistive device (LVAD), which impacts MS-DRGs 1, 2, 215, 268, and 269. CMS will continue to monitor data for changes in these MS-DRGs.

A list of laryngectomy codes will be identified for MS-DRGs 11, 12, and 13. The title for this MS-DRG triad will be Tracheostomy for face, mouth, neck diagnoses or laryngectomy. The chimeric antigen receptor (CAR) T-cell therapy should be assigned using ICD-10-PCS code XW033C3 or XW043C3. These procedure codes will be assigned to MS-DRG 16 and the title will be changed to Autologous bone marrow transplant w/CC/MCC or T-cell immunotherapy. 

MDC 1 (Diseases of the Nervous System): There are two diagnosis codes that will be assigned to MS-DRG 23 (Craniotomy w/major device implant or acute complex CNS PDX w/MCC or chemotherapy implant or epilepsy w/neurostimulator). These codes are G40.109 (Localization-related symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus) and G40.111 (Localization-related symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus).

MDC 5 (Diseases of the Circulatory System): All procedures that include an insertion of pacemaker device or lead will be included in MS-DRGs 260-262 (Cardiac pacemaker revision except device replacement). The “leadless” pacemakers are also included in these procedures. 

MDC 6 (Disorders of the Digestive System): Diagnosis code D17.71 (benign lipomatous neoplasm of the kidney) will be reassigned from MS-DRGs 393-395 (Other digestive diseases) to MS-DRGs 686-688 (Kidney and other urinary tract neoplasms).
Twelve ICD-10-PCS procedure codes (with open and laparoscopic approaches) for repair of colon or reposition of large and small intestines will be moved from MS-DRGs 329-331 (Major small and large bowel procedures) to MS-DRG 344-346 (Minor small and large bowel procedures.

MDC 8 (Diseases of the Musculoskeletal and Connective System): There were 99 ICD-10-PCS codes determined to be clinically invalid, which is to say that the codes include a device value of “no device.” According to Coding Clinic, Second Quarter 2017, a spinal fusion is coded only when the patient has a bone graft, an interbody fusion device, or a combination of interbody fusion device with a bone graft. Using that information, it is impossible to have a spinal fusion with no device. These procedure codes will be deleted from the classification system.
A review of the claims data found that these clinically invalid codes were reported more than 16,000 times. The code deletion will impact all of the spinal fusion MS-DRGs (453-460, 471-473).

MDC 11 (Diseases and Disorders of the Kidney and Urinary Tract): MS-DRG 685 (Admit for renal dialysis) will be deleted. The diagnosis codes of Z49.01, Z49.02, Z49.31, and Z49.32 will be reassigned to MS-DRGs 698-700 (Other kidney and urinary tract diagnoses). 

MDC 14 (Pregnancy, Childbirth, and Puerperium): MS-DRGs 765-767, 774-775, 777-778, 780-782 will be deleted, as the algorithm has been updated. The initial decision will be made if the patient delivered on this admission. If the answer is yes, then the next decision point in the algorithm is the type of delivery (vaginal vs. Cesarean Section).

The third decision will determine if the patient had a sterilization procedure. Instead of complicating diagnoses, the algorithm has been updated to include MCC, CC, or no MCC/CC. The new MS-DRGs are 783-788 (Cesarean section with and without sterilization w/MCC, CC, or no MCC/CC); 796-798 and 805-807 (Vaginal delivery with and without sterilization w/MCC, w/CC, or no MCC/CC); 817-819 and 831-833 (Other antepartum diagnosis with or without OR w/MCC, w/CC, or no MCC/CC).

A Medicare code edit (MCE) has been added to identify those cases that have a delivery diagnosis, but no delivery procedure code. 

MDC 18 (Infectious and Parasitic Diseases, Systemic or Unspecified Sites): Two diagnosis codes will be reassigned from MS-DRG 870-872 (Sepsis) to MS-DRG 864 (Fever and inflammatory conditions). These codes are R65.10 and R65.11 (SIRS of non-infectious origin with or without acute organ dysfunction).  

Changes to ICD-10-CM and ICD-10-PCS: The diagnosis codes for 2018 totaled 71,704, and the proposed total for 2019 is 71,902. This is an increase of 198 codes. The procedure codes for 2018 totaled 78,705, and the proposed total for 2019 is 78,533. This is a decrease of 172 codes. 

Based on the code total trends, it looks like the expansion of ICD-10 has slowed. And remember that ICD-11 is just around the corner!


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Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an 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 is a permanent panelist on Talk Ten Tuesdays

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