Good News in FY 2020 Inpatient Prospective Payment System Proposed Rule

FY 2020 IPPS RuleThe 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.

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 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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