It’s that time of year again. The first of the annual updates to the ICD-10 and MS-DRG systems is ready to go and will be effective October 1. As usual, diagnostic and procedure codes covering many different procedure types and body systems have been added, deleted and revised. MS-DRG grouping logic has also been updated to reflect ongoing analysis of CMS claims data and the coding changes for FY 2019.
The ICD-10 and MS-DRG updates reflect the final Hospital Inpatient Prospective Payment System (IPPS) rule for fiscal year 2019, published by CMS on August 6. You can see the details on IPPS here.
UASI Video Training: For Staff and Clients
Every year, UASI develops training for our staff. Outpatient coders may only need the ICD-10-CM training, while inpatient coders are more likely to need all three. You can see a recap of all the changes below.
Overall, the changes are designed to take advantage of ICD-10’s anatomical specificity. Thanks to ICD-10’s increasing maturity and refinement, this year’s modifications are somewhat less extensive than in previous years, which saw huge numbers of significant changes. That will seem like good news to many of us in the coding community.
The goal of this training is to promote data quality and consistency by demonstrating how to assign and report the new and revised diagnostic and procedure codes. We share the training with our clients, too, so their coding teams can adopt them as quickly and efficiently as possible. (UASI’s Laura Barron recently wrote about UASI’s commitment to education, which includes monthly coding tips and regular Webinars, in addition to the annual training on the code updates from CMS.)
Recapping ICD-10 and MS-DRG Updates for FY 2019
- Updated guidelines and new codes for both post-procedural infections of obstetrical and all other surgical wounds.
- Expansion of acute appendicitis codes to provide additional specificity when perforation, gangrene and abscess are also present.
- Expansion of anatomical specificity for all categories involving neoplasms of the eyelid to include not only laterality, but whether the upper or lower eyelid is affected.
- New codes for suspected or confirmed cases of adult and child sexual or labor exploitation.
- A new table in the Ear, Nose and Sinus body system has been created to distinguish procedures performed to control epistaxis from procedures to control bleeding elsewhere in the respiratory tract.
- New and revised device characters applicable to the Knee Joints have been established for FY 2019 to enable the capture of additional detail for knee arthroplasty procedures. These device characters can be found under the root operation Replacement and Removal.
- The qualifiers to describe the location of the incision made during a cesarean delivery on Table 10D have been revised for October 1st, 2018. This change will facilitate the appropriate classification of cesarean delivery procedures.
- For FY 2019 revisions have again been made to tables ORG and OSG by removing the device character “No Device (Z)”. Because a spinal fusion procedure always requires some type of device codes with the device character Z- No Device are considered clinically invalid. This will result in the deletion of 99 spinal fusion codes for FY 2019.
- Grouper logic changes to accommodate the new ECMO codes that differentiate central versus percutaneous insertions.
- Ten existing pregnancy DRGs have been deleted and eighteen new DRGs have been established and the logic to assigns DRGs in MDC 14 Pregnancy, Childbirth and the Puerperium have been completely revised and refined.
- Revision of the DRG logic to accommodate Chimeric Antigen Receptor (CAR) T-Cell therapy resulting in MS-DRG 016 Autologous Bone Marrow Transplant with CC/MCC to Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy.
- MS-DRG 685 is being deleted and re-assign ICD-10-CM diagnosis codes Z49.01, Z49.02, Z49.31, and Z49.32 from MS-DRG 685 to MS-DRGs 698, 699, and 700.