Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs

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Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs

  1. 1. Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs Barry Libman, RHIA, CCS, CCS-P President Barry Libman Inc.
  2. 2. Inpatient PPS, FY 2008 <ul><li>Agenda: </li></ul><ul><li>New codes </li></ul><ul><li>New Guidelines </li></ul><ul><li>Changes to the addenda </li></ul><ul><li>MS-DRGs </li></ul><ul><li>Get CEUs ! </li></ul>
  3. 3. Federal Register <ul><li>Federal Register / Vol. 72, No. 162 Wednesday, August 22, 2007, pp. 47130 - 48175 </li></ul><ul><li>http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3820.pdf </li></ul>
  4. 4. Codes Changes for FY 2007 <ul><li>Revisions and new codes will be implemented for discharges on or after October 1, 2007 </li></ul><ul><ul><li>122 New Diagnosis Codes </li></ul></ul><ul><ul><li>20 New V Codes </li></ul></ul><ul><ul><li>39 New Procedure Codes </li></ul></ul>
  5. 5. Infectious and Parasitic Diseases <ul><li>040.41 Infant botulism CC </li></ul><ul><li>040.42 Wound botulism CC </li></ul><ul><li>058.10 Roseola infantum, unspecified </li></ul><ul><li>058.11 … due to human herpesvirus 6 </li></ul><ul><li>058.12 … due to human herpesvirus 7 </li></ul>
  6. 6. Infectious and Parasitic Diseases <ul><li>058.21 Human herpesvirus 6 encephalitis MCC </li></ul><ul><li>058.29 Other human herpesvirus encephalitis MCC </li></ul><ul><li>058.81 Human herpesvirus 6 infection </li></ul><ul><li>058.82 Human herpesvirus 7 infection </li></ul><ul><li>058.89 Other human herpesvirus infection </li></ul><ul><li>079.83 Parvovirus B19 CC </li></ul>
  7. 7. Neoplasms <ul><li>200.30-38 Marginal zone lymphoma CC </li></ul><ul><li>200.40-48 Mantle cell lymphoma CC </li></ul><ul><li>200.50-58 Primary central nervous system lymphoma CC </li></ul><ul><li>200.60-68 Anaplastic large cell lymphoma CC </li></ul><ul><li>200.70-78 Large cell lymphoma CC </li></ul><ul><li>202.70-78 Peripheral T cell lymphoma CC </li></ul>
  8. 8. Neoplasms <ul><li>233.30 Carcinoma in situ, unspecified female genital organ </li></ul><ul><li>233.31 … vagina </li></ul><ul><li>233.32 … vulva </li></ul><ul><li>233.39 … other female genital organ </li></ul>
  9. 9. Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders <ul><li>255.41 Glucocorticoid deficiency CC </li></ul><ul><li>255.42 Mineralocorticoid deficiency CC </li></ul><ul><li>258.01 Multiple endocrine neoplasia [MEN] type I </li></ul><ul><li>258.02 … type IIA </li></ul><ul><li>258.03 … type IIB </li></ul>
  10. 10. Diseases of the Blood and Blood-Forming Organs <ul><li>284.81 Red cell aplasia (acquired)(adult)(with thymoma) MCC </li></ul><ul><li>284.89 Other specified aplastic anemias MCC </li></ul><ul><li>288.66 Bandemia </li></ul>
  11. 11. Mental Disorders <ul><li>315.34 Speech and language developmental delay due to hearing loss </li></ul>
  12. 12. Diseases of the Nervous System and Sense Organs <ul><li>331.5 Idiopathic normal pressure hydrocephalus (INPH) CC </li></ul><ul><li>359.21 Myotonic muscular dystrophy </li></ul><ul><li>359.22 … congenita </li></ul><ul><li>359.23 … chondrodystrophy </li></ul><ul><li>359.24 Drug induced myotonia </li></ul><ul><li>359.29 Other specified myotonic disorder </li></ul><ul><li>364.81 Floppy iris syndrome </li></ul><ul><li>364.89 Other disorders of iris and ciliary body </li></ul>
  13. 13. Diseases of the Nervous System and Sense Organs <ul><li>388.45 Acquired auditory processing disorder </li></ul><ul><li>389.05 Conductive hearing loss, unilateral </li></ul><ul><li>389.06 … bilateral </li></ul><ul><li>389.13 Neural hearing loss, unilateral </li></ul><ul><li>389.17 Sensory hearing loss, unilateral </li></ul><ul><li>389.20 Mixed hearing loss, unspecified </li></ul><ul><li>389.21 … unilateral </li></ul><ul><li>389.22 … bilateral </li></ul>
  14. 14. Diseases of Circulatory System <ul><li>414.2 Chronic total occlusion of coronary artery </li></ul><ul><li>415.12 Septic pulmonary embolism MCC </li></ul><ul><li>423.3 Cardiac tamponade CC </li></ul><ul><li>440.4 Chronic total occlusion of artery of the extremities </li></ul><ul><li>449 Septic arterial embolism CC </li></ul>
  15. 15. Diseases of the Respiratory System <ul><li>488 Influenza due to identified avian influenza virus </li></ul><ul><li>Notes on use of code 488: </li></ul><ul><ul><li>Code only confirmed cases of avian influenza. (This is an exception to the hospital inpatient guidelines for coding uncertain diagnoses. ) </li></ul></ul><ul><ul><li>“ Confirmation” does not require documentation of positive laboratory testing </li></ul></ul><ul><ul><li>Coding should be based on the provider’s diagnostic statement </li></ul></ul><ul><ul><li>If the provider records “suspected or possible or probable avian influenza,” the appropriate influenza code from category 487 should be assigned. </li></ul></ul><ul><ul><li>Similar to coding of HIV/AIDS </li></ul></ul>
  16. 16. Diseases of the Digestive System <ul><li>525.71 Osseointegration failure of dental implant </li></ul><ul><li>525.72 Post-osseointegration biological failure of dental implant </li></ul><ul><li>525.73 … mechanical failure … </li></ul><ul><li>525.79 Other endosseous dental implant failure </li></ul><ul><li>569.43 Anal sphincter tear (healed) (old) </li></ul>
  17. 17. Diseases of the Genitourinary System <ul><li>624.01 Vulvar intraepithelial neoplasia I [VIN I] </li></ul><ul><li>624.02 … neoplasia II [VIN II] </li></ul><ul><li>624.09 Other dystrophy of vulva </li></ul>
  18. 18. Complications of Pregnancy, Childbirth, and the Puerperium <ul><li>664.60 Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, unspecified as to episode of care or not applicable </li></ul><ul><li>664.61 … delivered, w/ or w/out mention of antepartum condition CC </li></ul><ul><li>664.64 … postpartum condition or complication CC </li></ul>
  19. 19. Diseases of the Musculoskeletal System and Connective Tissue <ul><li>733.45 Aseptic necrosis of bone, jaw CC </li></ul>
  20. 20. Symptoms, Signs, and Ill-Defined Conditions <ul><li>787.20 Dysphagia, unspecified </li></ul><ul><li>787.21 … oral phase </li></ul><ul><li>787.22 … oropharyngeal phase </li></ul><ul><li>787.23 … pharyngeal phase </li></ul><ul><li>787.24 … pharyngoesophageal phase </li></ul><ul><li>787.29 Other dysphagia </li></ul><ul><li>789.51 Malignant ascites CC </li></ul><ul><li>789.59 Other ascites CC </li></ul>
  21. 21. Injury and Poisoning <ul><li>999.31 Infection due to central venous catheter CC </li></ul><ul><li>999.39 Infection following other infusion, injection, transfusion, or vaccination CC </li></ul><ul><li>Please note: These codes were not included in the proposed rule but will be implemented on October 1, 2007. </li></ul>
  22. 22. V Codes <ul><li>Factors influencing health-status and contact with health service </li></ul><ul><li>20 new V Codes </li></ul>
  23. 23. V Codes <ul><li>V12.53 Personal history of sudden cardiac arrest </li></ul><ul><li>V12.54 Personal history of transient ischemic attack (TIA), and cerebral infarction w/out residual deficits </li></ul><ul><li>V13.22 Personal history of cervical dysplasia </li></ul>
  24. 24. V Codes <ul><li>V16.52 Family history of malignant neoplasm, bladder </li></ul><ul><li>V17.41 Family history of sudden cardiac death (SCD) </li></ul><ul><li>V17.49 Family history of other cardiovascular diseases </li></ul><ul><li>V18.11 Family history of multiple endocrine neoplasia [MEN] syndrome </li></ul><ul><li>V18.19 Family history of other endocrine and metabolic diseases </li></ul>
  25. 25. V Codes <ul><li>V25.04 Counseling and instruction in natural family planning to avoid pregnancy </li></ul><ul><li>V26.41 Procreative counseling and advice using natural family planning </li></ul><ul><li>V26.49 Other procreative management, counseling and advice </li></ul><ul><li>V26.81 Encounter for assisted reproductive fertility procedure cycle </li></ul><ul><li>V26.89 Other specified procreative management </li></ul>
  26. 26. V Codes <ul><li>V49.85 Dual sensory impairment </li></ul><ul><li>V68.01 Disability examination </li></ul><ul><li>V68.09 Other issue of medical certificates </li></ul><ul><li>V72.12 Encounter for hearing conservation and treatment </li></ul>
  27. 27. V Codes <ul><li>V73.81 Special screening examination, Human papillomavirus (HPV) </li></ul><ul><li>V84.81 Genetic susceptibility to multiple endocrine neoplasia [MEN] </li></ul><ul><li>V84.89 … other disease </li></ul>
  28. 28. Procedure Codes <ul><li>39 new Procedure Codes </li></ul><ul><li>Please note: Procedure Codes marked with an asterisk (*) were not included in the proposed rule but will be implemented on October 1, 2007. </li></ul>
  29. 29. Procedure Codes <ul><li>00.19 Disruption of blood brain barrier via infusion [BBBD] </li></ul><ul><li>00.94* Intra-operative neurophysiologic monitoring </li></ul><ul><li>01.10 Intracranial pressure monitoring </li></ul><ul><li>01.16 Intracranial oxygen monitoring </li></ul><ul><li>01.17 Brain temperature monitoring </li></ul>
  30. 30. Procedure Codes <ul><li>07.83* Thoracoscopic partial excision of thymus </li></ul><ul><li>07.84* … total excision of thymus </li></ul><ul><li>07.95* … incision of thymus </li></ul><ul><li>07.98* Other and unspecified thoracoscopic operations on thymus </li></ul>
  31. 31. Procedure Codes <ul><li>32.20* Thoracoscopic excision of lesion or tissue of lung </li></ul><ul><li>32.30* … segmental resection of lung </li></ul><ul><li>32.39* Other and unspecified segmental resection of lung </li></ul><ul><li>32.41 Thoracoscopic lobectomy of lung </li></ul><ul><li>32.49 Other lobectomy of lung </li></ul>
  32. 32. Procedure Codes <ul><li>32.50* Thoracoscopic pneumonectomy </li></ul><ul><li>32.59* Other and unspecified pneumonectomy </li></ul><ul><li>33.20 Thoracoscopic lung biopsy </li></ul><ul><li>34.06 … drainage of pleural cavity </li></ul><ul><li>34.20 … pleural biopsy </li></ul><ul><li>34.52 … decortication </li></ul>
  33. 33. Procedure Codes <ul><li>50.13* Transjugular liver biopsy </li></ul><ul><li>50.14* Laparoscopic liver biopsy </li></ul>
  34. 34. Procedure Codes <ul><li>70.53 Repair of cystocele and rectocele with graft or prosthesis </li></ul><ul><li>70.54 Repair of cystocele … </li></ul><ul><li>70.55 Repair of rectocele … </li></ul><ul><li>70.63 Vaginal construction with graft or prosthesis </li></ul><ul><li>70.64 Vaginal reconstruction … </li></ul><ul><li>70.78 Vaginal suspension and fixation … </li></ul>
  35. 35. Procedure Codes <ul><li>70.93 Other operations on cul-de-sac with graft or prosthesis </li></ul><ul><li>70.94 Insertion of biological graft </li></ul><ul><li>70.95 Insertion of synthetic graft or prosthesis </li></ul>
  36. 36. Procedure Codes <ul><li>84.80* Insertion or replacement of interspinous process device(s) </li></ul><ul><li>84.81* Revision of … </li></ul><ul><li>84.82* Insertion or replacement of pedicle-based dynamic stabilization device(s) </li></ul><ul><li>84.83* Revision of … </li></ul><ul><li>84.84* Insertion or replacement of facet replacement device(s) </li></ul><ul><li>84.85* Revision of … </li></ul>
  37. 37. Procedure Codes <ul><li>88.59 Intra-operative fluorescence vascular angiography </li></ul><ul><li>92.41* Intra-operative electron radiation therapy </li></ul>
  38. 38. Guidelines <ul><li>ICD-9-CM Official Guidelines for Coding and Reporting, Effective October 1, 2007 </li></ul><ul><li>www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf </li></ul>
  39. 39. Addenda to the ICD-9-CM Index <ul><li>Accident, accidental - see also condition </li></ul><ul><li>cerebrovascular (current) (CVA) (see also Disease, cerebrovascular, acute) 434.91 </li></ul><ul><li>aborted 434.91 </li></ul><ul><li>healed or old V12.54 </li></ul><ul><li>( See Coding Clinic Q3, 2007) </li></ul><ul><li>Anemia </li></ul><ul><li>postoperative </li></ul><ul><li>due to (acute) blood loss 285.1 </li></ul><ul><li>chronic blood loss 280.0 </li></ul>
  40. 40. Addenda to the ICD-9-CM Index <ul><li>Ascites 789.59 </li></ul><ul><li>abdominal NEC 789.59 </li></ul><ul><li>cancerous (M8000/6) 789.51 </li></ul><ul><li>malignant (M8000/6) 789.51 </li></ul><ul><li>pseudochylous 789.59 </li></ul>
  41. 41. Addenda to the ICD-9-CM Index <ul><li>CIDP (chronic inflammatory demyelinating polyneuropathy) 357.81 </li></ul><ul><li>Congestion, congestive (chronic) (passive) </li></ul><ul><li>chest 786.9 </li></ul><ul><li>lung 786.9 </li></ul><ul><li>nose 478.19 </li></ul><ul><li>Crush, crushed, crushing (injury) 929.9 </li></ul><ul><li>with </li></ul><ul><li>fracture - see Fracture, by site </li></ul>
  42. 42. Addenda to the ICD-9-CM Index <ul><li>Death </li></ul><ul><li>cardiac (sudden) (SCD) - see Disease, heart code to underlying condition </li></ul><ul><li>Deficit </li></ul><ul><li>neurologic NEC 781.99 </li></ul><ul><li>ischemic </li></ul><ul><li>reversible (RIND) 434.91 </li></ul><ul><li>history of (personal) V12.54 </li></ul><ul><li>prolonged (PRIND) 434.91 </li></ul><ul><li>history of (personal) V12.54 </li></ul>
  43. 43. Addenda to the ICD-9-CM Index <ul><li>Disease, diseased - see also Syndrome </li></ul><ul><li>liver 573.9 </li></ul><ul><li>end stage NEC 572.8 </li></ul><ul><li>due to hepatitis - see Hepatitis </li></ul><ul><li>Feeling of foreign body in throat 784.99 </li></ul><ul><li>Foreign body </li></ul><ul><li>feeling of, in throat 784.99 </li></ul><ul><li>throat, feeling of 784.99 </li></ul>
  44. 44. Addenda to the ICD-9-CM Index <ul><li>Fluid </li></ul><ul><li>peritoneal cavity 789.59 </li></ul><ul><li>malignant 789.51 </li></ul><ul><li>Findings, abnormal, without diagnosis (examination) (laboratory test) 796.4 </li></ul><ul><li>cholesterol 272.9 </li></ul><ul><li>high 272.0 </li></ul><ul><li>with high triglycerides 272.2 </li></ul>
  45. 45. Addenda to the ICD-9-CM Index <ul><li>History (personal) of </li></ul><ul><li>family </li></ul><ul><li>myocardial infarction V17.3 </li></ul><ul><li>sudden cardiac death (SCD) V17.41 </li></ul><ul><li>personal </li></ul><ul><li>sudden </li></ul><ul><li>cardiac </li></ul><ul><li>arrest V12.53 </li></ul><ul><li>death (successfully resuscitated) V12.53 </li></ul>
  46. 46. Addenda to the ICD-9-CM Index <ul><li>Neoplasia </li></ul><ul><li>vaginal intraepithelial I [VAIN I] 623.0 </li></ul><ul><li>vaginal intraepithelial II [VAIN II] 623.0 </li></ul><ul><li>vaginal intraepithelial III [VAIN III] 233.31 </li></ul><ul><li>vulvar intraepithelial I [VIN I] 624.01 </li></ul><ul><li>vulvar intraepithelial II [VIN II] 624.02 </li></ul><ul><li>vulvar intraepithelial III [VIN III] 233.32 </li></ul>
  47. 47. Addenda to the ICD-9-CM Index <ul><li>Long-term (current) drug use V58.69 </li></ul><ul><li>tamoxifen V58.69 </li></ul><ul><li>Pneumonia </li></ul><ul><li>ventilator associated 999.9 </li></ul><ul><li>Runny nose 784.99 </li></ul><ul><li>Scratchy throat 784.99 </li></ul>
  48. 48. Addenda to the ICD-9-CM Index <ul><li>Status (post) </li></ul><ul><li>sex reassignment surgery (see also Tran-sexualism) 302.50 </li></ul><ul><li>Stenosis (cicatricial) - see also Stricture </li></ul><ul><li>artery NEC (see also Arteriosclerosis) 447.1 </li></ul><ul><li>extremities 440.20 </li></ul><ul><li>Stroke 434.91 </li></ul><ul><li>in evolution 434.91 </li></ul>
  49. 49. Medicare Severity DRGs: MS-DRGs <ul><li>Effective for discharges beginning 10/1/07 </li></ul><ul><li>Why a severity adjusted classification system? </li></ul><ul><ul><li>ability to differentiate cases based on severity of illness and resource consumption </li></ul></ul><ul><li>The RAND report focuses on the following criteria: </li></ul><ul><ul><li>“ sensitivity to severity” </li></ul></ul><ul><ul><li>How well each classification system explains variation in resource use </li></ul></ul><ul><ul><li>Whether the groupings are manageable, administratively feasible and understandable </li></ul></ul><ul><ul><li>Payment accuracy </li></ul></ul>
  50. 50. Medicare Severity DRGs: MS-DRGs <ul><li>What is the same? </li></ul><ul><li>For Payment of Acute Hospital Inpatient Discharges </li></ul><ul><ul><li>Exempt: </li></ul></ul><ul><ul><ul><li>Critical Access Hospitals </li></ul></ul></ul><ul><ul><ul><li>Rehab Hospitals and units </li></ul></ul></ul><ul><ul><ul><li>Long Term Acute Care Hospitals </li></ul></ul></ul><ul><ul><ul><li>Psychiatric Hospitals and Units </li></ul></ul></ul><ul><ul><ul><li>Children’s Hospitals </li></ul></ul></ul><ul><ul><ul><li>Cancer Hospitals </li></ul></ul></ul>
  51. 51. Medicare Severity DRGs: MS-DRGs <ul><li>What is the same? </li></ul><ul><li>Admissions that are medically necessary are paid for under Medicare Part A by DRG payment methodology </li></ul><ul><li>Each MS-DRG has been assigned a payment weight based on average resources used to treat Medicare patients </li></ul><ul><li>Post acute care transfer payment policy </li></ul>
  52. 52. Medicare Severity DRGs: MS-DRGs <ul><li>What is the same? </li></ul><ul><li>The basic grouping process is the same </li></ul><ul><li>Principal diagnosis and up to 8 additional diagnoses ( ICD-9-CM) </li></ul><ul><li>Up to 6 procedure codes ( ICD-9-CM) </li></ul><ul><li>Gender and discharge status still affect some DRG assignments </li></ul>
  53. 53. Medicare Severity DRGs: MS-DRGs <ul><li>What is the same? </li></ul><ul><li>Still organized by Pre-MDC DRGs and 25 MDCs </li></ul>
  54. 54. Medicare Severity DRGs: MS-DRGs <ul><li>What is different? </li></ul><ul><li>Complete restructuring of the DRG system (745 DRGs in FY 2008 replacing 538 in FY 2007) </li></ul><ul><li>MS-DRG categories split by </li></ul><ul><ul><li>With Major CC </li></ul></ul><ul><ul><li>With CC </li></ul></ul><ul><ul><li>Without CC or MCC </li></ul></ul><ul><ul><li>(some exceptions) </li></ul></ul>
  55. 55. Medicare Severity DRGs: MS-DRGs <ul><li>What is different? </li></ul><ul><li>Addition of a Major CC List (1584 MCCs) </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType = none&filterByDID =-99&sortByDID=2&sortOrder= ascending&itemID =CMS1201733&intNumPerPage=10 </li></ul></ul><ul><li>Revision of the CC list (3343 CCs) </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType = none&filterByDID =-99&sortByDID=2&sortOrder= ascending&itemID =CMS1201734&intNumPerPage=10 </li></ul></ul>
  56. 56. Medicare Severity DRGs: MS-DRGs <ul><li>Simple Pneumonia and Pleurisy </li></ul><ul><li>DRG 193 w/ Major CC wt.1.2505 </li></ul><ul><li>DRG 194 w/ CC wt. 1.0235 </li></ul><ul><ul><li>(FY 07 wt. 1.0376) </li></ul></ul><ul><li>DRG 195 (w/out CC or MCC) wt. .8398 </li></ul><ul><ul><li>(FY 07 wt. .6148) </li></ul></ul>
  57. 57. Medicare Severity DRGs: MS-DRGs <ul><li>Major small and large bowel procedures </li></ul><ul><li>DRG 329 w/ Major CC wt. 4.5059 </li></ul><ul><ul><li>(FY 07 wt. 4.3425) </li></ul></ul><ul><li>DRG 330 w/ CC wt. 2.8935 </li></ul><ul><ul><li>(FY 07 wt. 2.6978) </li></ul></ul><ul><li>DRG 331 w/out CC or MCC wt. 1.8415 </li></ul><ul><ul><li>(FY 07 wt.1.4364) </li></ul></ul>
  58. 58. Medicare Severity DRGs: MS-DRGs <ul><li>Percutaneous Cardiovascular procedures </li></ul><ul><li>DRG 246 w/ drug-eluting stent w/ MCC or 4+ vessels or stents wt. 2.9046 </li></ul><ul><ul><li>(FY 07 wt. 2.7610) </li></ul></ul><ul><li>DRG 247 w/ drug-eluting stent w/o MCC wt. 2.1255 </li></ul><ul><ul><li>(FY 07 wt. 2.0814) </li></ul></ul><ul><li>4+ vessels or stents </li></ul><ul><li>36.07 and any of the following procedure combinations </li></ul><ul><ul><li>00.43 procedure 4+ vessels and 00.66 procedure PTCA or coronary atherectomy </li></ul></ul><ul><ul><li>00.48 insertion 4+ vascular stents and 00.66 procedure PTCA or coronary atherectomy </li></ul></ul>
  59. 59. Medicare Severity DRGs: MS-DRGs <ul><li>Nutritional and Metabolic Disorders (e.g., dehydration) </li></ul><ul><li>DRG 640 w/ Major CC wt. .9793 </li></ul><ul><ul><li>(FY 07 wt. .8334) </li></ul></ul><ul><li>DRG 641 w/out CC or MCC wt. .7248 </li></ul><ul><ul><li>(FY07 wt. .5090) </li></ul></ul><ul><li>Syncope and Collapse </li></ul><ul><li>DRG 312 wt. .7197 </li></ul><ul><ul><li>(FY 07 wt. .5024 or wt. .7627) </li></ul></ul>
  60. 60. Medicare Severity DRGs: MS-DRGs <ul><li>Congestive Heart Failure </li></ul><ul><li>291 Heart failure and shock w/ MCC wt. 1.2585 </li></ul><ul><ul><li>(FY 07 wt. 1.0485) </li></ul></ul><ul><li>292 Heart failure and shock w/ CC wt. 1.0134 (FY 07 wt. 1.0485) </li></ul><ul><li>293 Heart failure and shock w/out CC/MCC wt. 0.8765 </li></ul><ul><ul><li>(FY 07 wt. 1.0485) </li></ul></ul>
  61. 61. Medicare Severity DRGs: MS-DRGs <ul><li>Sepsis </li></ul><ul><li>870 Septicemia w/ MV 96+ hours wt. 5.7579 </li></ul><ul><ul><li>(FY 07 wt. 5.9388 or 1.8734) </li></ul></ul><ul><li>871 Septicemia w/out MV 96+ hours w/ MCC wt. 1.7484 </li></ul><ul><ul><li>(FY 07 wt. 1.5953) </li></ul></ul><ul><li>872 Septicemia w/out MV 96+ hours w/out MCC wt. 1.3783 </li></ul><ul><ul><li>(FY 07 wt. 1.5953) </li></ul></ul>
  62. 62. Medicare Severity DRGs: MS-DRGs <ul><li>Respiratory Failure </li></ul><ul><li>207 Respiratory system diagnosis w/ ventilator support 96+ hours wt. 5.1231 </li></ul><ul><ul><li>(FY 07 wt. 5.2294) </li></ul></ul><ul><li>208 Respiratory system diagnosis w/ ventilator support <96 hours wt. 2.2463 </li></ul><ul><ul><li>(FY 07 wt. 2.3335) </li></ul></ul>
  63. 63. Medicare Severity DRGs: MS-DRGs <ul><li>Selected Major CCs </li></ul><ul><li>Quadriplegia </li></ul><ul><li>Severe malnutrition </li></ul><ul><li>Toxic encephalopathy </li></ul><ul><li>Acute systolic congestive heart failure </li></ul><ul><li>Acute diastolic congestive heart failure </li></ul><ul><li>Pneumonia </li></ul><ul><li>Acute renal failure </li></ul><ul><li>End stage renal disease </li></ul><ul><li>Decubitus ulcers </li></ul><ul><li>Cardiogenic/septic shock </li></ul><ul><li>Fractures/burns </li></ul><ul><li>Sepsis/severe sepsis </li></ul>
  64. 64. Medicare Severity DRGs: MS-DRGs <ul><li>The following are Major CCs only for patients discharged alive, otherwise they are assigned as a non CC. </li></ul><ul><li>Diagnoses codes </li></ul><ul><ul><li>427.41 (Ventricular fibrillation) </li></ul></ul><ul><ul><li>427.5 (Cardiac arrest) </li></ul></ul><ul><ul><li>785.51 (Cardiogenic shock) </li></ul></ul><ul><ul><li>785.59 (Other shock w/out mention of trauma) </li></ul></ul><ul><ul><li>799.1 (Respiratory arrest) </li></ul></ul>
  65. 65. Medicare Severity DRGs: MS-DRGs <ul><li>A few CCs to keep in mind </li></ul><ul><ul><li>427.0 Paroxysmal supraventricular tachycardia </li></ul></ul><ul><ul><li>427.1 Paroxysmal ventricular tachycardia </li></ul></ul><ul><ul><li>427.32 Atrial Flutter </li></ul></ul><ul><ul><li>438.2x Late effects of CVA-Hemiplegia </li></ul></ul><ul><ul><li>599.0 Urinary tract infection </li></ul></ul><ul><li>Some Additions to the CC list </li></ul><ul><ul><li>V55.1 Attention to Gastrostomy </li></ul></ul><ul><ul><li>V62.84 Suicidal ideation </li></ul></ul><ul><ul><li>V85.0 Body Mass Index less than 19, adult </li></ul></ul><ul><ul><li>V85.4 Body Mass Index 40 and over, adult </li></ul></ul>
  66. 66. Medicare Severity DRGs: MS-DRGs <ul><li>No longer CCs (not a complete list) </li></ul><ul><ul><li>135 Sarcoidosis </li></ul></ul><ul><ul><li>138 Late effect acute polio </li></ul></ul><ul><ul><li>250.01 DMI w/out cmp nt st uncntrl </li></ul></ul><ul><ul><li>250.02 DMII w/out cmp uncntrld </li></ul></ul><ul><ul><li>250.03 DMI w/out cmp uncntrld </li></ul></ul><ul><ul><li>263.0 Malnutrition mod degree </li></ul></ul><ul><ul><li>263.1 Malnutrition mild degree </li></ul></ul><ul><ul><li>276.50 Volume depletion NOS </li></ul></ul><ul><ul><li>276.51 Dehydration </li></ul></ul><ul><ul><li>276.52 Hypovolemia </li></ul></ul><ul><ul><li>276.6 Fluid overload </li></ul></ul><ul><ul><li>276.7 Hyperpotassemia </li></ul></ul>
  67. 67. Medicare Severity DRGs: MS-DRGs <ul><li>No longer CCs (not a complete list) </li></ul><ul><ul><li>340 Multiple sclerosis </li></ul></ul><ul><ul><li>358.00 Myesthenia gravis w/out acute exacerbation </li></ul></ul><ul><ul><li>413.9 Angina pectoris NEC/NOS </li></ul></ul><ul><ul><li>424.0 Mitral valve disorder </li></ul></ul><ul><ul><li>424.1 Aortic valve disorder </li></ul></ul><ul><ul><li>427.31 Atrial fibrillation </li></ul></ul><ul><ul><li>428.0 CHF NOS </li></ul></ul><ul><ul><li>491.20 Obst chr bronc w/out exacerbation </li></ul></ul><ul><ul><li>492.8 Emphysema NEC </li></ul></ul><ul><ul><li>496 Chronic airway obstruct NEC </li></ul></ul><ul><ul><li>515 Postinflamatory pulmonary fibrosis </li></ul></ul>
  68. 68. Medicare Severity DRGs: MS-DRGs <ul><li>No longer CCs (not a complete list) </li></ul><ul><ul><li>536.40 Gastrostomy complication NOS </li></ul></ul><ul><ul><li>536.49 Gastrostomy complication NEC </li></ul></ul><ul><ul><li>571.2 Alcoholic cirrhosis liver </li></ul></ul><ul><ul><li>571.49 Chronic hepatitis NEC </li></ul></ul><ul><ul><li>571.5 Cirrhosis of liver NOS </li></ul></ul><ul><ul><li>571.6 Biliary cirrhosis </li></ul></ul><ul><ul><li>573.3 Hepatitis NOS </li></ul></ul><ul><ul><li>585.1 Chronic Kidney disease stage I </li></ul></ul><ul><ul><li>585.2 Chronic Kidney disease stage II </li></ul></ul><ul><ul><li>585.3 Chronic Kidney disease stage III </li></ul></ul><ul><ul><li>585.9 Chronic Kidney disease NOS </li></ul></ul><ul><ul><li>599.7 Hematuria </li></ul></ul>
  69. 69. Medicare Severity DRGs: MS-DRGs <ul><li>No longer CCs (not a complete list) </li></ul><ul><ul><li>696.0 Psoriatic arthropathy </li></ul></ul><ul><ul><li>710.0 Systemic lupus erythematosus </li></ul></ul><ul><ul><li>710.1 Systemic sclerosis </li></ul></ul><ul><ul><li>722.80 Postlaminectomy syndrome NOS </li></ul></ul><ul><ul><li>722.81 Postlaminectomy syndrome-cervical </li></ul></ul><ul><ul><li>722.82 Postlaminectomy syndrome-thoracic </li></ul></ul><ul><ul><li>722.83 Postlaminectomy syndrome-lumbar </li></ul></ul><ul><ul><li>780.39 Convulsions NEC </li></ul></ul><ul><ul><li>788.20 Retention urine NOS </li></ul></ul><ul><ul><li>997.5 Surgical complication-urinary tract </li></ul></ul><ul><ul><li>998.89 Other specific complication of procedure NEC </li></ul></ul><ul><ul><li>V42.2 Heart valve transplant </li></ul></ul><ul><ul><li>V45.1 Renal dialysis status </li></ul></ul>
  70. 70. Opportunities for Documentation Improvement <ul><li>Malnutrition </li></ul><ul><li>260 Kwashiorkor MCC </li></ul><ul><li>261 Nutritional marasmus MCC </li></ul><ul><li>262 Other severe protein-calorie malnutrition MCC </li></ul><ul><li>263.2 Arrested development following protein-calorie malnutrition CC </li></ul><ul><li>263.8 Other protein-calorie malnutrition CC </li></ul><ul><li>263.9 Unspecified protein-calorie malnutrition CC </li></ul><ul><li>263.0 Malnutrition of Moderate degree Not a CC </li></ul><ul><li>263.1 Malnutrition of Mild degree Not a CC </li></ul>
  71. 71. Opportunities for Documentation Improvement <ul><li>Congestive Heart Failure, Major CCs </li></ul><ul><li>428.21 Acute systolic heart failure MCC </li></ul><ul><li>428.23 Acute on chronic systolic heart failure MCC </li></ul><ul><li>428.31 Acute diastolic heart failure MCC </li></ul><ul><li>428.33 Acute on chronic diastolic heart failure MCC </li></ul><ul><li>428.41 Acute combined systolic and diastolic heart failure MCC </li></ul><ul><li>428.43 Acute on chronic combined systolic and diastolic heart failure MCC </li></ul>
  72. 72. Opportunities for Documentation Improvement <ul><li>Congestive Heart Failure, CCs </li></ul><ul><li>428.1 Left heart failure CC </li></ul><ul><li>428.20 Unspecified systolic heart failure CC </li></ul><ul><li>428.22 Chronic systolic heart failure CC </li></ul><ul><li>428.30 Unspecified diastolic heart failure CC </li></ul><ul><li>428.32 Chronic diastolic heart failure CC </li></ul><ul><li>428.40 Unspecified combined systolic and diastolic heart failure CC </li></ul><ul><li>428.42 Chronic combined systolic and diastolic heart failure CC </li></ul><ul><li>428.0 Congestive heart failure unspecified Not a CC </li></ul><ul><li>428.9 Heart Failure Unspecified Not a CC </li></ul>
  73. 73. Opportunities for Documentation Improvement <ul><li>Coding Clinic 2002 Q2 </li></ul><ul><li>For Inpatient Discharges, requires the attending physician to confirm the results of diagnostic testing in the progress notes or discharge summary. (Do not code from radiology or laboratory reports.) </li></ul><ul><li>Coding Clinic 2004 Q1 </li></ul><ul><li>For Inpatient Discharges, documentation from a physician other than the attending may be used for coding purposes as long as the documentation does not conflict with information written by the attending physician. </li></ul>
  74. 74. Resources <ul><li>Federal Register </li></ul><ul><ul><li>http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3820.pdf </li></ul></ul><ul><li>ICD-9-CM Official Guidelines for Coding and Reporting, Effective October 1, 2007 </li></ul><ul><ul><li>www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf </li></ul></ul><ul><li>Major CC List </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType = none&filterByDID =-99&sortByDID=2&sortOrder= ascending&itemID =CMS1201733&intNumPerPage=10 </li></ul></ul><ul><li>CC list </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType =none&filterByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS1201734&intNumPerPage=10 </li></ul></ul>
  75. 75. Resources <ul><li>Crosswalk V24.0 to V25.0 </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS1198678&intNumPerPage=10 </li></ul></ul><ul><li>V25.0 DRGs and Weights </li></ul><ul><ul><li>http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS1198553&intNumPerPage=10 </li></ul></ul><ul><li>Ingenix DRG Calculator </li></ul><ul><ul><li>https://www.hospitalbenchmarks.com/DRGCalculator.aspx </li></ul></ul><ul><li>3M MS-DRG V 25.0 Definitions Manual </li></ul><ul><li>Barry Libman Inc., Resources </li></ul><ul><ul><li>www.barrylibmaninc.com </li></ul></ul>
  76. 76. Recommendations <ul><li>Review the lists of new DRGS, major CCs and CCs </li></ul><ul><li>Test the new encoders </li></ul><ul><li>Practice, Practice, Practice </li></ul>
  77. 77. Questions? <ul><li>Barry Libman, RHIA, CCS, CCS-P </li></ul><ul><li>President, Barry Libman Inc. </li></ul><ul><li>978-369-7180 </li></ul><ul><li>Email: [email_address] </li></ul><ul><li>www.barrylibmaninc.com </li></ul>

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