CDI/Coder Companion: MS-DRGs and the IPPS in Fiscal Year …

1 2014-2016 CDI/Coder Companion: MS-DRGs and the IPPS in Fiscal Year 2019 2014-2016 VoyantWebNLP This corpus has 1 document with 703,916 total words and 18,746 unique word forms. 50 most frequent words Most frequent words in the corpus: fy (5466); cms (4556); hospital (4205); hospitals (3759); rule (3587); data (3358); measure (3244); proposed (3128); payment(3126); program (2903); ms (2893); measures (2688); ltch (2640); 1694 (2597); final (2443); care (2252); section (2238); ipps (2199); pps (2129); percent (2103); patients(2059); cases (2026); reporting (1968); cost (1943); drg (1852); commenters (1811); costs (1647); fr (1587); payments (1587); new (1583); based (1525); medicare(1474).

2 Rate (1374); year (1369); use (1366); average (1363); information (1228); patient (1227); drgs (1219); period (1209); procedure (1190); health (1174); quality(1149); stated (1148); applicant (1146); wage (1100); act (1089); commenter (1083); adjustment (1071); code (1055)2 2014-2016MS-DRG Documentation and coding AdjustmentWe note that, in this final rule, for FY 2019, we are not making a documentation and coding adjustment to the hospital-specific of the Postacute Care Transfer PolicyAccordingly, we are making conforming amendments to (c)

3 Of the regulation, effective for discharges on or after October 1, 2018, to specify that if a discharge is assigned to one of the MS-DRGs subject to the postacute care transfer policy and the individual is transferred to hospice care by a hospice program, the discharge is subject to payment as a transfer 2014-2016 Reduction of Hospital Payments for Excess ReadmissionsIn this final rule, we are establishing the applicable periods for FY 2019, FY 2020, and FY 2021. We also are codifying the definitions of dual-eligible patients, the proportion of dual-eligibles, and the applicable period for VBP ProgramWe are not finalizing our proposals to remove of the following six patient safety measures.

4 (1) NHSN CAUTI Outcome Measure (NQF #0138) (2) NHSN CLABSI Outcome Measure (NQF #0139)(3) ACS-CDC Harmonized Procedure SSI Outcome Measure (NQF #0753) (4) NHSN Facility-wide Inpatient Hospital-onset Bacteremia MRSA Outcome Measure (NQF #1716)(5) NHSN Facility-wide Inpatient Hospital-onset CDI Outcome Measure (NQF #1717)(6) Patient Safety and Adverse Events (Composite) (NQF #0531) PSI 90 2014-2016 Hospital-Acquired Condition (HAC) Reduction ProgramIn this final rule, we are: (1) establishing administrative policies to collect, validate, and publicly report NHSN healthcare-associated infection (HAI) quality measure data that facilitate a seamless transition, independent of the Hospital IQR Program, beginning with January 1, 2020 infectious events; (2) changing the scoring methodology by removing domains and assigning equal weighting to each measure for which a hospital has a measure; and (3) establishing the applicable period for FY 2021.

5 In addition, we are summarizing comments we received regarding the potential future inclusion of additional measures, including Inpatient Quality Reporting (IQR) ProgramIn this final rule, we are making several changes. As part of agency-wide efforts under the Meaningful Measures Initiative to use a parsimonious set of the most meaningful measures for patients and clinicians in our quality programs and the Patients Over Paperwork initiative to reduce burden, cost, and program complexity, as discussed in section of the preamble of this final rule, we are adding a new measure removal factor and removing a total of 39 measures from the Hospital IQR Program.

6 We are finalizing a modified version of our proposal to remove 5 of those measures such that removal is delayed by 1 year. For a full list of measures being removed, we refer readers to section of the preamble of this final rule. 2014-20166 Summary of IQR Program Measures Newly Finalized for Removal 2014-20167 Summary of IQR Program Measures Newly Finalized for Removal 2014-2016MS-DRG UpdatesWe are making the FY 2019 ICD-10 MS-DRG GROUPER and Medicare Code Editor (MCE) Software Version 36, the ICD-10 MS-DRG Definitions Manual files Version 36 and the Definitions of Medicare Code Edits Manual Version 36 available to the public on our CMS Web site at: 2014-2016 Pre-MDC.

7 Heart Transplant or Implant of Heart Assist SystemThe commenters agreed with CMS that current claims data do not yet reflect recent advice published in coding Clinic for ICD-10-CM/PCS regarding the coding of procedures involving external heart assist devices or recent changes to ICD-10-PCS codes for these procedures .. After consideration of the public comments we received, we are maintaining the current structure of Pre-MDC MS-DRGs 001 and 002 for FY 2014-2016 Pre-MDC: LaryngectomyAfter consideration of the public comments we received, we are finalizing our proposal to reorder the lists of diagnoses and procedure codes for Pre-MDC MS-DRGs 11, 12, and 13 in the ICD-10 MS-DRG Definitions Manual Version 36.

8 We also are finalizing our proposal to revise the titles for Pre-MDC MS-DRGs 11, 12, and 13 as follows for the ICD-10 MS-DRGs Version 36, effective October 1, 2018: MS-DRG 11 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC); MS-DRG 12 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC); and MS-DRG 13 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC).10 2014-2016 Pre-MDC: Chimeric Antigen Receptor (CAR) T-Cell TherapyAfter consideration of the public comments we received, we are finalizing our proposed approach of assigning ICD-10-PCS procedure codes XW033C3 and XW043C3 to Pre-MDC MS-DRG 016 for FY 2019 and to revise the title of MS-DRG 016 from Autologous Bone Marrow Transplant with CC/MCC to Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy.

9 11 2014-2016 MDC 1: Epilepsy with NeurostimulatorAfter consideration of the public comments we received, we are finalizing our proposal to add ICD-10-CM diagnosis codes (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus) and (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus) to the list of epilepsy diagnosis codes for assignment to MS-DRG 023 in the ICD-10 MS-DRGs Version 36, effective October 1, 2014-2016 MDC 5.

10 Pacemaker InsertionsAfter consideration of the public comments we received, we are finalizing the lists of the procedure codes in Tables , Table , and Table associated with the proposed rule, with the addition of ICD-10-PCS procedure codes 02H63MZ and 02H73MZ to be included for the pacemaker insertion code pairs and as stand-alone codes for the insertion of a pacemaker lead, as reflected in Tables and associated with this final rule. We also are finalizing our proposal to maintain the current GROUPER logic for MS-DRGs 258 and 259 and for MS-DRGs 260, 261, and 262 under the ICD-10 Version 36, effective October 1, 2014-2016 MDC 6: Benign Lipomatous Neoplasm of Kidney.