The document summarizes changes to Medicare Severity Diagnosis Related Groups (MS-DRGs) and ICD-10 codes for 2019 and provides an outlook for 2020. In 2019, 15 MS-DRGs were deleted and 19 were added, and there were 435 ICD-10 code changes. For 2020, 28 MS-DRGs were deleted and 28 added, along with 252 new ICD-10 diagnosis codes and 1,660 deleted ICD-10 procedure codes. The biggest changes related to peripheral ECMO and transcatheter mitral valve repair. The areas most impacted by severity shifts were various body systems and factors influencing healthcare status. Two DRGs were removed from the transfer policy list while three new ones did not

1. MS DRG Changes –
2019 recap and 2020 look ahead

2. Because IPPS hospitals are paid based on Medicare Severity
Diagnosis Related Groups (MS-DRG), additions, deletions, or
alterations to MS DRGs can affect how hospitals should
submit claims to Medicare.

3. 2019 MS DRG and
ICD 10 Changes

4. MS DRG changes in the 2019 final rule
• MS DRGs increased from 754 to 759
• DRGs deleted: 685,765, 766, 767, 774, 775, 777, 778, 780, 781,
782
• DRGs added: 783, 784, 785, 786, 787, 788, 797, 798, 799, 805,
806, 807, 817, 818, 819, 831, 832 and 833
• For 2019, there were no additional DRGs that were impacted by the
transfer policy

5. MS DRG changes in the 2019 final rule
• The biggest change impacted the transfer policy was the addition of
hospice being included as impacted by the rule.
• Transfers to 50 (hospice home) and 51 (hospice inpatient) with a
DRG included in the rule and a length of stay below the GMLOS will
result in a per diem payment.
• This increased the overall impact of the transfer rule to all
providers.

6. ICD-10 changes in the 2019 final rule
• 435 ICD-10 code changes
• 247 new codes
• 139 revised codes
• 49 deleted codes

7. 2020 changes

8. In the 2020 IPPS final rule…
• An analysis was completed with ICD-10 claim data from 2018
Medpar data, No MS-DRG data were examined. They examined
resource consumption and patient care costs.
• There is an estimated $3.4 billion increase in CMS payments,
representing a 3.1% increase over last year.

9. 2020 DRG Changes
• MS DRGs remain constant at 761
• 28 DRGs were deleted
• 207, 291, 296, 870, 014, 034-036, 176, 216-221, 228, 229,
273, 274, 548, 549, 550, 459, 460, 691, 692, 769, 776
• 28 DRGS were added
• 003, 016, 017, 037, 038, 039,175, 266, 267, 319, 320, 260,
261, 262, 485, 486, 487, 456, 457, 458, 693, 694, 817, 818,
819, 831, 832, 833

10. 2020 ICD-10 Changes
• 252 ICD-10-CM (diagnosis) codes added
• 1,660 ICD-10-PCS (procedure) codes deleted

11. The biggest changes were related to the peripheral ECMO changes
and the transcatheter mitral valve repair with implant.
Additionally, other specified conditions affecting pregnancy,
childbirth and puerperium were reclassified as
antepartum conditions.

12. The areas that are impacted predominantly with
the severity shift are Neoplasms, Circulatory
System, Skin and Subcutaneous Tissue,
Genitourinary Systems, Injury and Poisoning, and
Factors Influencing Healthcare Status.
Bronchoalveolar lavage, percutaneous drainage of
the pelvic cavity and percutaneous removal of a
drainage device are all moved from an OR
category to a Non-OR classification.
These changes impact the
DRG changes and moved their
corresponding classifications.

13. MS DRG changes affecting
the Transfer DRG Rule

14. For 2020, there are only 278 DRGs that
will be impacted by the transfer policy.
This represents a drop in 2 DRGS that
will be impacted by the rule.
Based on the final rule to revise
the MS-DRG classifications and
on the additional ICD-10 codes,
there were changes to the DRGs
impacted by the transfer policy.

15. MS–DRGs 273 and 274 are currently subject to the post-acute care transfer
policy and are being removed from the list for 2020.
MS– DRGs 693 and 694 are currently not subject to the post-acute care
transfer policy revised and do not qualify in 2020, even though they were
reclassified.
The new MS–DRGs 319 and 320 also do not qualify to be included on the
list of DRGs that are subject to the post-acute care transfer policy.

16. MS DRG changes can affect how Transfer DRG
underpayments and overpayments are properly
recovered.
Without displacing or disrupting a current review
vendor or internal process, BESLER can provide a
secondary validation of impacted transfer claims
to ensure you are identifying all potential
underpayments and overpayments.
*HFMA staff and volunteers determined that Transfer DRG Revenue Recovery Service has met certain criteria developed under
the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service.
Learn how to
recover more
Transfer DRG
underpayments
besler.com/transfer-drg-revenue-recovery