Health Information Management

CMS releases 2013 IPPS Final Rule: Quality initiatives, value-based purchasing, and CC/MCC changes

HIM-HIPAA Insider, August 6, 2012

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Inpatient facilities received mixed news on proposed changes to the list of complications and comorbidities (CC) and major CCs (MCC) in the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) final rule, released August 1.

In addition, CMS added two conditions to the list of hospital-acquired conditions (HAC), finalized operational details for the Hospital Value-Based Purchasing (VBP) Program, and made changes to the Hospital Inpatient Quality Reporting (IQR) Program.

CMS also added one procedure code to the ICD-9-CM Volume 3 code set: 00.95 (injection or infusion of glucarpidase). Because of the partial code freeze prior to ICD-10 implementation, the ICD-9-CM Maintenance and Coordination Committee did not add, revise, or delete any diagnosis codes. CMS did not revise or delete any procedure codes for 2013. CCs and MCCs

CMS chose not to include code 428.0 (congestive heart failure, unspecified) as a CC. That disappoints James S. Kennedy, MD, CCS, CDIP, managing director at FTI Consulting in Atlanta, because in some instances of acute heart failure, no systolic or diastolic heart muscle disease is present, such as in acute aortic or mitral insufficiency.

In other cases the treating physician or surgeon simply did not want to incur unnecessary healthcare spending to get an echocardiogram needed to determine whether the heart failure is currently systolic or diastolic.

“I estimate that 20% of concurrent CDI work is to clarify this very issue which, if classifying 428.0 as a CC was approved as requested, would have reduced the work and hassle involved in clarifying systolic or diastolic heart failure and improve hospital efficiency and cost which, in turn, could be passed along to the government,” Kennedy says.

Click here to read more on the HCPro website.

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