ICD-10 implementation will arrive in weeks, and many facilities are putting the final touches on their preparations. Yet many have not looked at looming MS-DRG shifts.
Various assessments by CMS, Milliman, and 3M found that the MS-DRG assigned to an ICD-10 claim did not always match the MS-DRG assigned to an ICD-9-CM source claim. The change in DRGs in ICD-10 compared to ICD-9-CM is referred to as MS-DRG shift, says Gloryanne Bryant, RHIA, RHIT, CCS, CDIP, CCDS, an AHIMA-approved ICD-10-CM/PCS trainer with more than 30 years of experience in HIM.
The CMS and 3M studies have determined that overall, approximately 1% of MS-DRGs will shift under ICD-10. "To most of us that seems very, very small," Bryant says.
However, facilities need to break down which MS-DRGs are shifting. "If those shifts are in more common MS-DRGs that we see in our patient population, the impact could be greater," Bryant says.
Of the 1.07% of MS-DRGs that will shift, 41% will shift to a higher-paying MS-DRG, while 66% will move to a lower-paying MS-DRG, according to a CMS study.
CMS has indicated that the MS-DRG payment calculation under ICD-10 will be a replication of the current system, Bryant says. Although CMS has indicated that this change will be budget neutral, there will be some payment redistribution based on the differences between ICD-9-CM and ICD-10.