• E-mail
• Print
• RSS

Tip: Watch for new ICD-9-CM pressure ulcer codes and their impending impact on MS-DRG assignment

CDI Strategies, May 29, 2008

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

Today, 90% of Medicare Severity DRGs (MS-DRG) fall into one of three buckets:

• With a CC
• With a major CC (MCC)
• Without a CC or MCC

On October 1, 2008, this percentage will change when CMS implements the Inpatient Prospective Payment System (IPPS) final rule. At that time, the CC/MCC structure will alter slightly due to newly proposed ICD-9-CM codes.

For example, ICD-9-CM may expand pressure ulcer codes to capture the stages of the ulcers. Staging information is important for proper wound care, and it is a predictor of severity and resource utilization. The newly proposed codes are as follows:

• 707.20 (Pressure ulcer, unspecified stage)
• 707.21 (Pressure ulcer stage I)
• 707.22 (Pressure ulcer stage II)
• 707.23 (Pressure ulcer stage III)
• 707.24 (Pressure ulcer stage IV)

CMS will consider the new codes for stages III and IV pressure ulcers to be MCCs. However, CMS will not consider the other stages to be a CC or an MCC. And the existing decubitus ulcer codes will no longer be a CC or MCC either.

When coders report stage III or IV pressure ulcers as hospital-acquired, it will fall under the hospital-acquired condition payment provision. Capturing the stage of the pressure ulcer will be crucial in garnering proper reimbursement.

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

• Comment
• E-mail to a Colleague
• Print
• RSS
• Archive

Comments