Good News in FY 2020 Inpatient Prospective Payment System Proposed (IPPS) Rule
IPPS Proposed Rule

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 (IPPS)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 (IPPS) 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 SPOT

The seven previously mentioned proposed changes to the IPPS 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 IPPS MS-DRGs with the associated relative weights by topic.

Topic Actions Original
MS-DRG
FY19 RW New
MS-DRG
FY20
FRW
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 IPPS 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 IPPS 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.   

FOR MORE INFORMATION

https://www.icd10monitor.com/good-news-in-fy-2020-inpatient-prospective-payment-system-proposed-rule

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