OASIS Alert

Published on Fri Oct 26, 2007 PDF

The Centers for Medicare & Medi-caid Services' final rule on the prospective payment system not only expands diagnoses in the existing case mix diagnosis groups, it multiplies the number of groups more than five-fold.

Instead of the current four case mix diagnosis groups (neurological, orthopedic, diabetes and burns and trauma), the rule expands and breaks diagnoses out into these 22 new groups including hundreds of codes:

• Blindness and low vision

• Blood disorders

• Cancer and selected benign neoplasms

• Diabetes

• Dysphagia

• Gait abnormality

• Gastrointestinal disorders

• Heart disease

• Hypertension

• Neuro 1 - Brain disorders and paralysis

• Neuro 2 - Peripheral neurological disorders

• Neuro 3 - Stroke

• Neuro 4 - Multiple sclerosis

• Ortho 1 - Leg disorders

• Ortho 2 - Other orthopedic disorders

• Psych 1 - Affective and other psychoses, depression

• Psych 2 - Degenerative and other organic psychiatric disorders

• Pulmonary disorders

• Skin 1 - Traumatic wounds, burns and post-operative complications

• Skin 2 - Ulcers and other skin conditions

• Tracheostomy care (new from proposed)

• Urostomy/cystostomy care (new from proposed)

Note: For specific case mix codes, see Table 2B in the PPS refinements final rule at www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms1541fc.pdf.