Inpatient Facility Coding & Compliance Alert

Revised guidelines, additions, deletions, reimbursement mappings and more…

Prepare yourself for the new and revised ICD-10-CM and ICD-10-PCS codes that go into effect Oct. 1, 2016, along with the associated DRG changes. This April 19, CMS posted the much awaited IPPS update for the fiscal year (FY) 2017. This IPPS update was significant as it rolls out the very first revision to the ICD-10-codes, and a snowball effect will ensue on all its related entities: GEMs, reimbursement mappings and more.

“At the very least, coding staff will have to take the time to study the changes,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. “Physicians, most likely through Medical Staff Organization meetings/workshops, will also need updating. How all of this will play out through the DRG grouper, and thus overall payment, is yet another issue.”

Major Revisions in Cardiovascular Codes

According to the ICD-10-PCS codes update for fiscal year (FY) 2017, you have 3,651 new and 487 revised PCS codes. And of those new codes, a whopping 3,549 (97 percent) belong to the cardiovascular system. These changes pertain to cardiac coding, MDC 5, and refurnishing the options that we used to have in ICD-9, but were deprived of in ICD-10. These relate to unique device values, addition of bifurcation as a qualifier, additional specific body parts, congenital cardiac procedures, and placement of intravascular neurostimulators. For example, you now have:

• 48 new codes for coronary artery bypass (0210083 to 021348W)
• 208 new codes for bypass of a cardiac chamber or a major vessel(021608P to 021608R)
• 144 more codes for dilation of coronary artery (ies) with increasing number of drug eluting intraluminal devices (0270056 to 02734GZ).

There are thousands of more such codes awaiting you, and we hope to bring you pertinent information about these in upcoming issues.

ICD-10-PCS Code Changes 

-50 new codes were added for FY2016 
-New section X New Technology created for classifying new technology procedures 
-No code titles were revised for FY2016 

What’s In It for Inpatient Coders?

The proposed rule contains numerous grouping changes in many sections due to issues relating to duplication and disparity, comparing the ICD-9 grouping with ICD-10 grouping. To resolve this, it was proposed to add multiple procedure and diagnosis codes to the Major Diagnostic Categories (MDCs).

So here we are, with 84 proposed additions to the MCC list ranging from I60.2 (Nontraumatic subarachnoid hemorrhage from anterior communicating artery) to S02.11HB (Other fracture or occiput, left side, initial encounter for open fracture) for open fracture. Further, it’s time you remove K85.0 (Idiopathic acute pancreatitis) from your MCC list. The 326 proposed additions to the CC list include diagnoses such as fractures of various parts of skull, jaw and foot, and even conditions such as T83.113A, (Breakdown [mechanical] of other urinary stents, initial encounter). Please remember to strike off F34.8 (Other persistent mood [affective] disorders) from your CC list.

Know your MS-DRG reshuffle: Concomitantly, there are some areas with a reallocation of conditions and their respective MS-DRGs. There is a proposal to bring down the severity level from three to two, by revising MS-DRG 229 (Other cardiothoracic procedures W CC) and deleting MS-DRG 230 (Other cardiothoracic procedures W/O CC/MCC). Furthermore, laminectomy decompression has been proposed to be reassigned to MS-DRG 028 (Spinal procedures W CC) through MS-DRG 030 (Spinal procedures W/O CC MCC).

 “This whole area continues to increase in complexity and level of detail,” admits Abbey. “The coding cannot be any better than the documentation provided, so it really goes back to the physicians, the documentation process and the ability of coding staff to work with physicians.”

New Section X on New Technology Has its Own Standalone Status

In a separate small section on new technology is the new section of X codes, which are standalone codes representing the procedure as per the code title completely. They do not require any additional codes from other sections of ICD-10-PCS.

For example, you can code XW04321 (Introduction of Ceftazidime-Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1) to indicate administration of Ceftazidime-Avibactam Anti-infective through a central vein. You are not required to code separately from table 3E0, given in the Administration section of the Codeset manual, thinking that you need to resort to that section so as to report administration of a medication intravenously.

The new technology section includes nine proposals for new services and technology add-on proposals, including MAGEC^® Spine, Titan Spine EndoSkeleton nanoLOCK^TM, GORE EXCLUDER^® Iliac branch Endoprosthesis, Idarucizumab, and Andexanet alfa.

“The release of the new ICD-10-PCS and ICD-10 CM codes will provide additional time for the industry to prepare, and the new codes will enhance the specificity of patient stories captured in their health records,” said AHIMA CEO Lynne Thomas Gordon in a statement to http://journal.ahima.org on March 23, 2016.

The road ahead: “There is no simple way to address this increasing complexity, “declares Abbey. “The coding staff deserve recognition for their ongoing efforts and hospital administrative staff should make certain that time is allocated for study and that educational opportunities are available.”

Inpatient coders today are faced with the complexity that is every growing. “Even with academic training the learning curve is enormous and a student should anticipate years of experience to even begin mastery,” opines Abbey.

Link: http://journal.ahima.org/2016/03/23/code-freeze-ends-with-release-of-new-icd-10-cmpcs-codes/)