Good News in FY 2020 Inpatient Prospective Payment System Proposed Rule

The FY 2020 Inpatient Prospective Payment System (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.

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.

In summary, there is some good news in the FY20 Inpatient Prospective Payment System (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 https://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.

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