Health Information Management

Healthcare News: CC, MCC, DRG, and HAC changes in the FY 2013 IPPS proposed rule

JustCoding News: Inpatient, May 9, 2012

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Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.

In addition, the IPPS proposed rule contains provisions to strengthen the Hospital Inpatient Quality Reporting Program and proposes new policies and measures for the Hospital Value-Based Purchasing Program.

CMS did not propose any major changes to the ICD-9-CM code set, which stands true to the original plan of doing a minimal update to ICD-9-CM for 2012, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, Inc, in Danvers, Mass. “Since we are proposing to use ICD-9-CM until October 1, 2014, it potentially adds another year of limited updates.”

CCs, MCCs, and DRGs
For FY 2013, CMS proposes to reassign cases with a principal diagnosis code 487.0 (influenza with pneumonia) and one of a list of pneumonia codes listed as a secondary diagnosis from MS-DRGs 193, 194, and 195 to MS-DRGs 177, 178, and 179. CMS proposes to make three additional codes CCs and change one MCC to a CC for FY 2013. It does not plan to add any MCCs or delete any CCs.

CMS proposes adding these diagnoses to the CC list:

  • 263.0, Malnutrition of moderate degree
  • 263.1, Malnutrition of mild degree
  • 440.4, Chronic total occlusion of artery of the extremities

It also is proposing to change the severity level of diagnosis code 584.8 (acute kidney failure with other specified pathological lesion in kidney) from an MCC to a CC.

Additions to the HAC list
CMS proposes adding two conditions to the list of hospital acquired conditions (HAC) for 2013: surgical site infection following cardiac implantable electronic device (CIED) and iatrogenic pneumothorax with venous catheterization.

Inpatient facilities do not receive higher MS-DRG payments for patients with complications or major complications caused by the conditions on the HAC list. CMS also plans to add two codes, 999.32 (bloodstream infection due to central catheter) and 999.33 (local infection due to central venous catheter) to the existing vascular catheter-associated infection HAC category.

With these additions, there was no need for new codes. CMS just states that the combination of these diagnosis and procedure codes would be identified as a HAC, McCall says.

This is not the first time CMS has proposed to add pneumothorax to the HAC list. CMS proposed adding pneumothorax associated with transbronchial biopsy several years ago, but it was not finalized, McCall says.

This condition does seem to meet HAC the criteria of occurring commonly and can cause a significant increase in resource consumption in order to treat this condition, she says. It is also labeled as a CC. However, HACs must also be reasonably preventable, according to evidence-based research, and this has also kept other conditions, such as ventilator-associated pneumonia, off the list in the past.

The addition of the surgical site infections from CIEDs seems to follow along with the inclusion of other site infections already on the HAC list, especially given an increased focus on ensuring sterile environments to avoid contamination of a primary infection at the time of placement of such devices, McCall says.

Comment on the proposed rule
CMS will accept comments on the proposed rule until June 25 and will respond to all comments in a final rule to be issued by August 1. Facilities can download a display copy of the proposed rule here. The proposed rule will appear in the May 11 Federal Register.

Click here to read more about the IPPS proposed rule.

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