CMS addresses MS-DRG changes due to ICD-10 in 2017 IPPS proposed rule

April 22, 2016
Medicare Web

CMS issued the fiscal year (FY) 2017 IPPS proposed rule Monday with updates to several MS-DRG classifications and relative weights. 

Proposed changes include, but are not limited to, the following procedures and diagnoses:

  • Bypass procedures of the veins (MS-DRGs 405, 406, and 407)

  • Endovascular embolization or occlusion of head and neck procedures (MS-DRGs 270, 271, and 272)

  • Localized swelling, mass, and lump, trunk (ICD-10-CM code R22.2)

  • Other cardiothoracic procedures without MCC (MS-DRGs 228, 229, and 230)

  • Pacemaker procedures (for MS-DRGs 242, 243, and 244)

  • Sequelae of stroke (ICD-10-CM category I69)

The amount of proposed MS-DRG changes, said Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, a division of BLR, in Danvers, Massachusetts, was expected due to the transition to IDC-10.

“But, there were, as expected, also a fair number of ‘replication errors’ that had to be remedied due to the transition of ICD-9 to ICD-10,” McCall said. “Particular codes weren’t included at all in the MS-DRGs where they should have been included, or codes that were mislabeled as an OR procedure when they historically were a non-OR procedure.”

This, McCall said, resulted in MS-DRGs being classified as surgical versus medical in some cases, which likely resulted in overpayment.

Because of these setbacks, providers requested numerous MS-DRG category updates, with one notable change proposed for other cardiothoracic procedures without MCC.

CMS proposed to collapse MS-DRGs 228, 229, and 230 from three severity levels to two by deleting MS-DRG 230 and revising MS-DRG 229.

CMS proposed to reassign ICD-9-CM procedure code 35.97 and the cases reporting ICD-10-PCS procedure code 02UG3JZ (Supplement mitral valve with synthetic substitute, percutaneous approach) from MS-DRGs 273 and 274 to MS-DRG 228 and the proposed revised MS-DRG 229, and modify the title of MS-DRG 229 to “Other Cardiothoracic Procedures without MCC,” to reflect the “without MCC” designation. MS-DRG 228 would remain as “Other Cardiothoracic Procedures with MCC.”

“Interestingly, it appears the focus on this trio of DRGs was at first to determine appropriate grouping for Mitraclip (mitral valve repair procedure), but it opened the door to additional scrutiny on MS-DRGs 228-230 to determine if there is enough of a differential in the costs to have three levels,” McCall said.

Collapsing into a two-level severity could impact facilities, McCall said, depending on the relative weight that is assigned. 

While many changes have been proposed, the amount of change requests that were denied may have a large impact on coders and physicians as well.

McCall said that for FY 2017, CMS did not address issues with the following, which can leave unanswered questions for coders and clinical documentation improvement teams:

  • Diagnostic or therapeutic paracentesis

  • Incision and drainage procedures on subcutaneous tissues and deeper

  • Wound procedures, such as non-excisional debridement

As CMS continues to refine the ICD-10 MS-DRGs for FY 2018, the agency is requesting providers contact them regarding ICD-10-PCS codes that capture procedures that would not reasonably be performed. Comments should be sent to by December 7.

For more information on the rule, see CMS’ fact sheet. Comments on the 2017 IPPS proposed rule are due to CMS by June 16, and the agency expects to issue a final rule by August 1. Once finalized, changes will become effective October 1.

Medicare Compliance Watch will take a more in-depth look at aspects of the proposed rule throughout the coming weeks, and look to upcoming issues of JustCoding and Briefing on Coding Compliance Strategies for more coverage and analysis of the rule.

Related Topics: 
Coding, IPPS