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ICD-9-CM and MS-DRG Update FY 2012Presented by: Laurie M. Johnson, MS, RHIA, CPC-H

AHIMA Certified ICD-10-CM/PCS TrainerSeptember 9, 2011

2Proprietary and Confidential. Do not distribute.

Session Objectives

• Review new ICD-9-CM Codes

• Review latest changes to ICD-10

• Understand the most recent changes to MS-DRGs

• Discuss other topics in FY12 Final Rule

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ICD-9-CM Updates FY 2012

Presented by: Laurie M. Johnson, MS, RHIA, CPC-HOptumInsightSeptember 9, 2011


Overall New Code Distribution

• New Diagnosis Codes

– Chapter 1 (001 – 139) - 4

– Chapter 2 (140 – 239) - 40

– Chapter 3 (240 – 279) - 0

– Chapter 4 (280 – 289) - 12

– Chapter 5 (290 – 319) - 4

– Chapter 6 (320 – 389) - 13

– Chapter 7 (390 – 459) - 6

– Chapter 8 (460 – 519) - 28

– Chapter 9 (520 – 579) - 5

– Chapter 10 (580 – 629) - 6

– Chapter 11 (630 – 679)- 4

• New Diagnosis Codes (con’t)

– Chapter 12 (680 – 709) - 2

– Chapter 13 (710 – 739) - 1

– Chapter 14 (740 – 759) - 3

– Chapter 15 (760 – 779) - 0

– Chapter 16 (780 – 799) - 4

– Chapter 17 (800 – 999) - 19

– Chapter 18 (V01 – V91) - 17

– Chapter 19 (E codes) -

• New Procedure Codes - 19

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FY12 Update vs. Documentation

• Malignant neoplasm of skin vs. basal cell carcinoma vs. squamous cell carcinoma

• Specific types of thalassemia

• Antineoplastic chemotherapy causing pancytopenia vs. other drug induced pancytopenia

• Acquired vs. congenital hemophilia

• Behavior disorder associated with dementia

• Specific type of glaucoma

• Stages of glaucoma (mild, moderate, severe, indeterminate)

• Saddle embolism vs. other embolism of abdominal aorta

• Primary vs. Secondary vs. Chronic pneumothorax

• Acute vs. Chronic vs. Acute/Chronic respiratory failure associated with trauma and surgery

• Relationship of condition to a procedure


New Diagnosis Codes - Infections

Other and unspecified Escherichia coli [E. coli]041.49

Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified

041.43

Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC)

041.42

Shiga toxin-producing Escherichia coli [E. coli] (STEC) O157041.41

DescriptionDiagnosis Code

4


New Diagnosis Codes - Neoplasms

CCCode DescriptionDiagnosis Code

NOther specified malignant neoplasm of eyelid, including canthus

173.19

NSquamous cell carcinoma of eyelid, including canthus173.12

NBasal cell carcinoma of eyelid, including canthus173.11

NUnspecified malignant neoplasm of eyelid, including canthus

173.10

NOther specified malignant neoplasm of skin of lip173.09

NSquamous cell carcinoma of skin of lip173.02NBasal cell carcinoma of skin of lip173.01NUnspecified malignant neoplasm of skin of lip173.00




NOther specified malignant neoplasm of skin of other and unspecified parts of face

173.39

NSquamous cell carcinoma of skin of other and unspecified parts of face

173.32

NBasal cell carcinoma of skin of other and unspecified parts of face

173.31

NUnspecified malignant neoplasm of skin of other and unspecified parts of face

173.30

NOther specified malignant neoplasm of skin of ear and external auditory canal

173.29

NSquamous cell carcinoma of skin of ear and external auditory canal

173.22NBasal cell carcinoma of skin of ear and external auditory canal173.21

NUnspecified malignant neoplasm of skin of ear and external auditory canal

173.20

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NUnspecified malignant neoplasm of scalp and skin of neck

173.40

NBasal cell carcinoma of scalp and skin of neck173.41


NOther specified malignant neoplasm of skin of trunk, except scrotum

173.59

NSquamous cell carcinoma of skin of trunk, except scrotum173.52

NBasal cell carcinoma of skin of trunk, except scrotum173.51

NUnspecified malignant neoplasm of skin of trunk, except scrotum

173.50

NOther specified malignant neoplasm of scalp and skin of neck

173.49

NSquamous cell carcinoma of scalp and skin of neck173.42




NOther specified malignant neoplasm of skin of lower limb, including hip

173.79NSquamous cell carcinoma of skin of lower limb, including hip173.72NBasal cell carcinoma of skin of lower limb, including hip173.71

NUnspecified malignant neoplasm of skin of lower limb, including hip

173.70

NOther specified malignant neoplasm of skin of upper limb, including shoulder

173.69

NSquamous cell carcinoma of skin of upper limb, including shoulder

173.62

NBasal cell carcinoma of skin of upper limb, including shoulder

173.61

NUnspecified malignant neoplasm of skin of upper limb, including shoulder

173.60

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NOther specified malignant neoplasm of skin, site unspecified173.99

NSquamous cell carcinoma of skin, site unspecified173.92

NBasal cell carcinoma of skin, site unspecified173.91NUnspecified malignant neoplasm of skin, site unspecified173.90

NOther specified malignant neoplasm of other specified sites of skin

173.89

NSquamous cell carcinoma of other specified sites of skin173.82

NBasal cell carcinoma of other specified sites of skin173.81

NUnspecified malignant neoplasm of other specified sites of skin

173.80


Skin Cancers

• Basal Cell Carcinoma

– Basal cell carcinoma is a type of nonmelanoma skin cancer, and is the most common form of cancer in the United States.

– According to the American Cancer Society, 75% of all skin cancers are basal cell carcinomas.

– Begins in the epidermis

– At risk if you are blond haired, blue/green eyed, light skinned

• Squamous Cell Carcinoma

– Squamous cell cancer occurs when cells in the skin start to change.

– The changes may begin in normal skin or in skin that has been injured or inflamed.

– Most skin cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation.

– Skin cancer is most often seen in people over age 50.

– At risk if you are blond haired, blue/green eyed, light skinned

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New Diagnosis Codes – Blood/Blood Forming Organs

CC/ MCC

Code DescriptionDiagnosis Code

NThalassemia, Unspecified282.40*

MCCAntineoplastic chemotherapy induced pancytopenia284.11*

NHemoglobin E-beta thalassemia282.47*NThalassemia minor282.46*NDelta-beta thalassemia282.45*

NBeta thalassemia282.44*

NAlpha thalassemia282.43*


Thalassemia

• Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen.

• The disorder results in excessive destruction of red blood cells, which leads to anemia.

• There are two main types of thalassemia:

– Alpha thalassemia occurs when a gene or genes related to the alpha globin protein are missing or changed (mutated).

– Beta thalassemia occurs when similar gene defects affect production of the beta globin protein.

• Symptoms can include:

– Bone deformities in the face

– Fatigue

– Growth failure

– Shortness of breath

– Yellow skin (jaundice)

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New Diagnosis Codes – Blood/Blood Forming Organs

CC/ MCC


CCOther hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors

286.59

CCAntiphospholipid antibody with hemorrhagic disorder286.53

CCAcquired hemophilia286.52

CCOther pancytopenia284.19*

MCCOther drug-induced pancytopenia284.12*


New Diagnosis Codes - Mental

CC/ MCC


NOther specified nonpsychotic mental disorders following organic brain damage

310.89

NPseudobulbar affect310.81

CC2Dementia, unspecified, with behavioral disturbance294.21

NDementia, unspecified, without behavioral disturbance294.20

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New Diagnosis Codes - Nervous

CC/ MCC


CCLambert-Eaton syndrome in other diseases classified elsewhere

358.39

CCLambert-Eaton syndrome in neoplastic disease358.31

CCLambert-Eaton syndrome, unspecified358.30

MCC2Brain death348.82

NCorticobasal degeneration331.6


Lambert-Eaton Syndrome

• Lambert-Eaton syndrome is a disorder in which faulty communication between nerves and muscles leads to muscle weakness

• Lambert-Eaton syndrome occurs when nerves cells do not release enough of a chemical called acetylcholine. This chemical transmits impulses between nerves and muscles.

• Symptoms may include:– Weakness or loss of movement that can be more or less severe, including:

• Difficulty chewing• Difficulty climbing stairs • Difficulty lifting objects • Difficulty talking • Drooping head • Need to use hands to get up from sitting or lying positions

– Swallowing difficulty, gagging, or choking• Vision changes such as: • Blurry vision • Double vision • Problems keeping a steady gaze

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New Diagnosis Codes - Nervous

NVitreomacular adhesion 379.27*

CC/ MCC


NIndeterminate stage glaucoma365.74

NSevere stage glaucoma365.73

NModerate stage glaucoma365.72

NMild stage glaucoma365.71

NGlaucoma stage, unspecified365.70

NPrimary angle closure without glaucoma damage365.06

NOpen angle with borderline findings, high risk365.05


New Diagnosis Code - Circulatory

CC/ MCC


CCOther arterial embolism and thrombosis of abdominal aorta

444.09

MCCSaddle embolus of abdominal aorta444.01

CCOther hypertrophic cardiomyopathy425.18*

CCHypertrophic obstructive cardiomyopathy425.11*

MCCSaddle embolus of pulmonary artery415.13

NCoronary atherosclerosis due to calcified coronary lesion

414.4*

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New Diagnosis Codes - Respiratory

CC/ MCC


CCOther pneumothorax512.89*CCOther air leak512.84*CCChronic pneumothorax512.83*CCSecondary spontaneous pneumothorax512.82*CCPrimary spontaneous pneumothorax512.81*

CCPostoperative air leak512.2*NRespiratory conditions due to smoke inhalation508.2*

NInfluenza due to identified novel influenza A virus with other manifestations

488.89*

NInfluenza due to identified novel influenza A virus with other respiratory manifestations

488.82*

MCCInfluenza due to identified novel influenza A virus with pneumonia

488.81*



CC/ MCC


CCAdult pulmonary Langerhans cell histiocytosis516.5MCCLymphangioleiomyomatosis516.4CCDesquamative interstitial pneumonia516.37CCCryptogenic organizing pneumonia516.36CCIdiopathic lymphoid interstitial pneumonia516.35NRespiratory bronchiolitis interstitial lung disease516.34CCAcute interstitial pneumonitis516.33*NIdiopathic non-specific interstitial pneumonitis516.32NIdiopathic pulmonary fibrosis516.31N2Idiopathic interstitial pneumonia, not otherwise specified516.30

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CC/ MCC


MCCAcute and chronic respiratory failure following trauma and surgery

518.53*

MCCOther pulmonary insufficiency, not elsewhere classified, following trauma and surgery

518.52*MCCAcute respiratory failure following trauma and surgery518.51*

MCCOther interstitial lung diseases of childhood516.69

MCCAlveolar capillary dysplasia with vein misalignment516.64

MCCSurfactant mutations of the lung516.63MCCPulmonary interstitial glycogenosis516.62

MCCNeuroendocrine cell hyperplasia of infancy516.61


New Diagnosis Codes - Digestive

CC/ MCC


NHepatopulmonary syndrome573.5*

CCOther complications of other bariatric procedure539.89

CCInfection due to other bariatric procedure539.81

CCOther complications of gastric band procedure539.09

CCInfection due to gastric band procedure539.01

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New Diagnosis Code - Urinary

CC/ MCC


NExposure of implanted vaginal mesh and other prosthetic materials into vagina

629.32

NErosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue

629.31

NOther specified disorders of bladder596.89

CCOther complication of cystostomy596.83

CCMechanical complication of cystostomy596.82

CCInfection of cystostomy596.81


New Diagnosis Codes - Pregnancy

CC/ MCC


NOnset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with mention of postpartum complication

649.82

NOnset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section, delivered, with or without mention of antepartum condition

649.81NOther abnormal products of conception631.8

NInappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy

631.0

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New Diagnosis Codes – Skin/Subcutaneous

CC/ MCC


NTrichilemmal cyst704.42

NPilar cyst704.41


Pilar Cyst

• Pilar cysts are common, occurring in 5-10% of the population.[1] Greater than 90% occur on the scalp, where pilar cysts are the most common cutaneous cyst.

• Pilar cysts are the second most frequent type of cyst on the head and neck.[2, 3] Pilar cysts are almost always benign, malignant transformation being extremely rare.

• Pilar cysts may be sporadic or may be autosomal dominantly inherited.[4] They contain keratin and its breakdown products and are lined by walls resembling the external (outer) root sheath of the hair.

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Trichilemmal Cyst

• Trichilemmal cysts are derived from the outer root sheath of the hair follicle.

• Their origin is unknown, but it has been suggested that they areproduced by budding from the external root sheath as a geneticallydetermined structural aberration.

• They arise preferentially in areas of high hair follicle concentrations, therefore, 90% of cases occur on the scalp.

• They are solitary in 30% of cases and multiple in 70% of cases


New Diagnosis Codes - Musculoskeletal

NPartial tear of rotator cuff726.13*

CC/ MCC


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New Diagnosis Codes – Congenital Anomalies

CC/ MCC


MCCOther anomalies of pulmonary artery and pulmonary circulation

747.39

MCCPulmonary arteriovenous malformation747.32

MCCPulmonary artery coarctation and atresia747.31


New Diagnosis Codes – Perinatal Conditions

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New Diagnosis Codes – Signs/Symptoms

CC/ MCC


NNonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis

795.52*

NNonspecific reaction to tuberculin skin test without active tuberculosis

795.51*

NOther nonspecific abnormal finding of lung field793.19*

NSolitary pulmonary nodule793.11*


New Diagnosis Codes – Injury/Poisoning

CC/ MCC


CCPostoperative shock, unspecified998.00*

CCOther digestive system complications997.49

CCRetained cholelithiasis following cholecystectomy997.41

CCPostprocedural aspiration pneumonia997.32CCComplications of transplanted organ, stem cell996.88

MCCMultiple open pelvic fractures without disruption of pelvic circle

808.54

CCMultiple closed pelvic fractures without disruption of pelvic circle

808.44

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CC/ MCC


CCAcute infection following transfusion, infusion, or injection of blood and blood products

999.34*

CCLocal infection due to central venous catheter999.33*

CCBloodstream infection due to central venous catheter999.32*

MCCPostoperative shock, other998.09*

MCCPostoperative shock, septic998.02*

MCCPostoperative shock, cardiogenic998.01*



CC/ MCC


CCOther serum reaction999.59

CCOther serum reaction due to vaccination999.52

CCOther serum reaction due to administration of blood and blood products

999.51

CCAnaphylactic reaction due to other serum999.49

CCAnaphylactic reaction due to vaccination999.42

CCAnaphylactic reaction due to administration of blood and blood products

999.41

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New Diagnosis Codes – V Codes

CC/ MCC


NOther specified behavioral problemV40.39*NWandering in diseases classified elsewhereV40.31*NPregnancy with inconclusive fetal viabilityV23.87NPregnancy with history of ectopic pregnancyV23.42NFamily history of other specified eye disorderV19.19NFamily history of glaucomaV19.11NPersonal history of other specified diseasesV13.89NPersonal history of anaphylaxisV13.81NPersonal history of pulmonary embolismV12.55

NPersonal history of other endocrine, metabolic, and immunity disorders

V12.29NPersonal history of gestational diabetesV12.21


New Diagnosis Codes – V Codes

CC/ MCC


NAcquired absence of other jointV88.29NAcquired absence of knee jointV88.22NAcquired absence of hip jointV88.21NContact with and (suspected) exposure to uraniumV87.02NLong term (current) use of bisphosphonatesV58.68*NAftercare following explantation of joint prosthesisV54.82

•Notes:

•* These diagnosis codes were discussed at the March 9–10, 2011 ICD-9-CM Coordination and Maintenance Committee meeting and were not finalized in time to include in the FY 2012 IPPS/LTCH PPS proposed rule. They will be implemented on October 1, 2011.

•1 Secondary diagnosis of major problem

•2 Please note the CC designation has changed from the proposed rule.

•3 On "Secondary Diagnosis" list

•4 Significant trauma body site - pelvis or spine

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New Procedure Codes

OR?Code DescriptionProc Code

NInsertion of antimicrobial envelope17.81*

YAtherectomy of other non-coronary vessel(s)17.56*

YTransluminal coronary atherectomy17.55*

YPercutaneous atherectomy of intracranial vessel(s)17.54*

YPercutaneous atherectomy of extracranial vessel(s)17.53*

YInsertion of aqueous drainage device12.67*

YIntracranial ventricular shunt or anastomosis02.22*

YInsertion or replacement of external ventricular drain [EVD]02.21*


New Procedure Codes

YEndovascular replacement of aortic valve35.05*

YTransapical replacement of aortic valve35.06*

YEndovascular replacement of pulmonary valve35.07*

YTransapical replacement of pulmonary valve35.08*

OR?Code DescriptionProc Code

YUterine artery embolization [UAE] without coils68.25*YUterine artery embolization [UAE] with coils68.24*

YLaparoscopic vertical (sleeve) gastrectomy43.82*

YEndovascular implantation of branching or fenestrated graft(s) in aorta

39.78*YTemporary (partial) therapeutic endovascular occlusion of vessel39.77*

YInsertion of implantable pressure sensor without lead for intracardiac or great vessel hemodynamic monitoring

38.26

YEndovascular replacement of unspecified heart valve35.09*

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ICD-9-CM Official Coding and Reporting Guideline Changes


2012 ICD-9-CM Guideline Update

• Initially released on August 11, 2011

• Revised version released August 23, 2011

• 107 pages

• Available at http://www.cdc.gov/nchs/data/icd9/icd9cm_guidelines_2011.pdf

• Updates

– Documentation of Complications of Care

– Glaucoma

– POA

• Congenital

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Documentation of Complications of Care

• New Section

• Documentation of Complications of care

– Code assignment is based on the provider’s documentation of the relationship between the condition and the care or procedure. The guideline extends to any complications of care, regardless of the chapter the code is located in. It is important to note that not all conditions that occur during or following medical care or surgery are classified as complications. There must be a cause-and-effect relationship between the care provided and the condition, and anindication in the documentation that it is a complication. Query the provider for clarification, if the complication is not clearly documented.

• Use additional code to identify nature of complication

– An additional code identifying the complication should be assigned with codes in categories 996-999, Complications of Surgical and Medical Care NEC, when the additional code provides greater specificity as to the nature of the condition. If the complication code fully describes the condition, no additional code is necessary.


Documentation of Complications of Care

• Kidney transplant complications

– Conditions that affect the function of the transplanted kidney, other than CKD, should be assigned code 996.81, Complications of transplanted organ, Kidney, and a secondary code that identifies the complication.

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Categories of V Codes

• Contact/Exposure

– Codes V15.84 – V15.86 describe contact with or (suspected) exposure to asbestos, potentially hazardous body fluids, and lead.

– Subcategories V87.0 – V87.3 describe contact with or (suspected) exposure to hazardous metals, aromatic compounds, other potentially hazardous chemicals, and other potentially hazardoussubstances.


Glaucoma

• Glaucoma – for codes 365.1 – 365.6, add code from subcategory 365.7 to identify the glaucoma stage

• Bilateral glaucoma with same stage– Assign code for glaucoma type – Assign code for glaucoma stage

• Bilateral glaucoma with different stages– Assign code for glaucoma type– Assign code for highest stage of glaucoma documented

• Bilateral glaucoma with different types and different stages– Assign code for each type of glaucoma– Assign code for highest stage of glaucoma documented

• Glaucoma stage evolves during admission– Assign highest glaucoma stage documented

• Indeterminate stage of glaucoma– 365.74 (glaucoma of indeterminate stage) is assigned based on clinical

documentation– Glaucoma stage can not be clinically determined– Do not confuse with glaucoma stage unspecified, 374.70

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Present on Admission Updates

• Congenital conditions and anomalies

– Assign “Y” for congenital conditions and anomalies, except for categories 740-759, Congenital anomalies, which are on the exempt list. Congenital conditions are always considered present on admission.

ICD-10 Update for FY 2012

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ICD-10 in the US

• Final Rule was published January 16, 2009 with an effective date of March 17, 2009 and an implementation date of October 1, 2013.

• ICD-10-CM is administered by NCVHS.

• ICD-10-PCS is administered by CMS.

• New updates to ICD-10 will be published in late December/early January 2011.


ICD-10 Coding Guidelines

• 2011 Diagnosis version available (replaces 2010 version)

• 2012 Diagnosis version will not be posted until after December 1,2011

• Diagnosis Guidelines are available at:

http://www.cdc.gov/nchs/data/icd9/10cmguidelines2011_FINAL.pdf

• Contact for ICD-10-CM questions, contact Donna Pickett at [email protected]

• 2012 Procedure codes available at http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage

• Procedure Guidelines are available at: http://www.cms.gov/ICD10/Downloads/PCS_2012_guidelines.pdf

• 2012 ICD-10-PCS GEMs will be posted October 1, 2011 with the reimbursement mapper posted after December 1, 2011.

• Contact for ICD-10-PCS: [email protected]

71,9181,3453811,18272,081

2012

Total

Deleted Codes

Revised Codes

New Codes

2011 Total

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September 2011 Coordination & Maintenance Committee Meeting Report

• Coordination & Maintenance Meeting will meet on September 14th.

– Procedure codes will be discussed from 9:00 AM – 12:30 PM EDT

• The agenda is available at http://www.cms.gov/ICD9ProviderDiagnosticCodes/Downloads/091411_Agenda.pdf

• Electromagnetic Tip for Nodules

• ICD-10-PCS

– Diagnosis codes will be discussed from 1:30 PM – 5:30 PM

• The agenda is available at http://www.cdc.gov/nchs/data/icd9/tentativeagendaSept142011.pdf

• ICD-10-CM Diagnoses

– You can attend via audioconference without registering.

– Dial in access for external participants is 1-877-267-1577 Meeting ID: 1234

Inpatient Prospective Payment System FY12

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Final Rule FY2012• Available at http://www.gpo.gov/fdsys/pkg/FR-2011-08-18/pdf/2011-

19719.pdf.

• Final Rule was released In Federal Register on August 18, 2011

• 751 MS-DRGs across 25 MDCs

• Relative weight calibration was based on MedPAR data from October 1, 2009 through September 30, 2010 based on bills received by March 31, 2011.

• MS-DRGs are based on:

– Age

– Sex

– Principal Diagnosis

– DRG Operating Room Procedures

– CC/MCC

– Discharge Status

– Present on Admission (effective 10/1/2008)


Documentation and Coding Adjustment

• Implementation of the MS-DRGs included an adjustment to payments based on expected documentation and coding improvement.

• For FY 2011 Rule setting MedPAR data 2009 was reviewed to estimate the percentage of increased payments due to improvements in Documentation and Coding. This was determined to be 5.4 % based on available data.

• The impact of documentation and coding from FY09 (FY08 and FY09)yields a cumulative coding and documentation adjustment of 1.5%

• A 2.9% adjustment to the standardized rate will be implemented for FY11 (total adjustment of 4.4%).

• CMS is planning to implement an increase of 2.0% adjustment for FY12.

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Current Hospital Acquired Conditions

707.23 (MCC)

707.24 (MCC)

Pressure Ulcer Stages III & IV

999.60, 999.61, 999.62, 999.63, 999.69 (CC)

Blood Incompatibility

999.1 (MCC)Air Embolism

998.4 (CC)

998.7 (CC)

Foreign Object Retained After Surgery

CC/MCC

(ICD-9-CM Code)HAC

Currently designated conditions which may affect reimbursement if the only CC or MCC on the case include



519.2 (MCC)

And one of the following

procedure codes:

36.10–36.19

Surgical Site Infection, Mediastinitis, Following

Coronary Artery Bypass Graft (CABG)

999.31 (CC)Vascular Catheter-Associated Infection

Codes within these ranges

on the CC/MCC list:

800-829

830-839

850-854

925-929

940-949

991-994

Falls and Trauma:

- Fracture

- Dislocation

- Intracranial Injury

- Crushing Injury

- Burn

- Other Injuries (formerly Electric Shock)

CC/MCC /ICD-9-CM Code

HAC

29



996.64 (CC)

Also excludes the following

from acting as a CC/MCC:

112.2 (CC)

590.10 (CC)

590.11 (MCC)

590.2 (MCC)

590.3 (CC)

590.80 (CC)

590.81 (CC)

595.0 (CC)

597.0 (CC)

599.0 (CC)

Catheter-Associated Urinary Tract Infection (UTI)

CC/MCCHAC



996.67 (CC)

998.59 (CC)


procedure codes: 81.01-

81.08, 81.23-81.24, 81.31-

81.38, 81.83, 81.85

Surgical Site Infection Following Certain Orthopedic Procedures

Principal Diagnosis – 278.01

998.59 (CC)

539.01 (CC) or 539.81 (CC)


procedure codes: 44.38,

44.39, or 44.95

Surgical Site Infection Following Bariatric Surgery for Obesity

CC/MCCHAC

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415.11 (MCC)

415.13 (MCC)

415.19 (MCC)

453.40-453.42 (MCC)

And one of the following procedure codes: 00.85-00.87, 81.51-81.52, or 81.54

Deep Vein Thrombosis and Pulmonary Embolism

Following Certain Orthopedic Procedures

CC/MCCHAC


POA Indicators

Signifies exemption from POA reporting. CMS established this code as a workaround to blank reporting on the electronic 4010A1. A list of exempt ICD-9-CM diagnosis codes is available in the ICD-9-CM Official Guidelines for Coding and Reporting.

1

Indicates that the documentation is insufficient to determine if the condition was present at the time of admission.

U

Indicates that the condition was not present on admission.N

Affirms that the provider has determined based on data and clinical judgment that it is not possible to document when the onset of the condition occurred.

W

Indicates that the condition was present on admission.Y

DescriptorIndicator

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POA Statistics FY11 vs. FY12

74,382,681Total

9.36%

0.21%

6.72%

0.02%

83.69%

FY11

(%)

9.33%6,938,487Exempt1

2.99%2,223,318Documentation not adequate to determine if present on admission

U

6.72%5,001,138Not present on admission

N

0.02%13,145Can not be determined clinically

W

80.94%60,206,593Present on Admission

Y

FY12

(%)

Number Indicator Description

POA


POA Statistics FY12

• RTI Report is available at http://www.rti.org/reports/cms/.

• Applies to discharges October 2009 through September 2010

• 3,572 discharges were impacted by the HAC Policy

• Savings of $21,450,095.

• Average case savings of $6,005

• Most frequent category reported the resulted in a re-assignment to the MS-DRG was Trauma and Falls which resulted in $9,200,708 from 1,672 cases..

• Total of 317,644 cases were reported with HAC conditions as secondary diagnosis.

• 19,143 discharges (6%) were reported with POA indicator of N or U.

• 94 discharges had 2 HACs reported on the same admission with 15 resulting in MS-DRG reassignment.

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Medicare Code Edit Update

• Noncovered procedures

– Add 43.82 (laparoscopic sleeve gastrectomylaparoscopic sleeve gastrectomy)


Surgical Hierarchy• In Pre-MDC, new MS-DRGs 016 and 017 will be added above

MS-DRG 010 (Pancreas Transplant).

• In MDC 09, new MS-DRGs 570, 571, and 572 will be added above MS-DRG 579 (Other Skin, Subcutaneous Tissue, and Breast Procedures with MCC) and below MS-DRG 578 (Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC)

33


CC Exclusion List

• The list is available at http://www.cms.gov/AcuteInpatientPPS/IPPS2011/list.asp#TopOfPage

• Remove diagnosis codes 707.23 (Pressure ulcer, stage III) and 707.24 (Pressure ulcer, stage IV) from the CC Exclusion List when reported with a principal diagnosis code of 707.0X (where X equals any value 0 - 7, 9).

• Add diagnosis code 585.6 (End-stage renal disease) to the CC Exclusion List when reported with a principal diagnosis code of 403.90 (Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified).

• Add diagnosis code 403.91 (Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end-stage renal disease) to the CC Exclusion List when reported with a principal diagnosis code of 585.6 (End-stage renal disease).


MS-DRG 15

• Delete MS-DRG 15 (Autologous Bone Marrow Transplant)

• Create MS–DRG 016 (Autologous Bone Marrow Transplant with CC/MCC); and MS–DRG 017 (Autologous Bone Marrow Transplant without CC/MCC).

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MS-DRG 023 and 024

• Assign rechargeable dual array systems for deepbrain stimulationcases identified by reporting both procedure codes 02.93 and 86.98.


MS-DRGs 237-238

• Removing procedure codes 38.45 and 39.73 from MS–DRGs 237 and 238 and adding these two codes to the following six MS–DRGs: 216; 217; 218; 219; 220; and 221.

• Revise the title of MS–DRG 237 to read ‘‘Major Cardiovascular Procedureswith MCC.’’

• The title of MS–DRG 238 (Major Cardiovascular Procedures without MCC) will remain the same.

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New MS-DRGs 570 - 572

• Based on procedure code 86.22

– MS–DRG 570 (Skin Debridement with MCC)

– MS–DRG 571 (Skin debridement with CC)

– MS–DRG 572 (Skin Debridement without CC/MCC)

• Exclude 86.22 from the following MS-DRGs

– Revised MS–DRG 573 (Skin Graft for Skin Ulcer or Cellulitis with MCC)

– Revised MS–DRG 574 (Skin Graft for Skin Ulcer or Cellulitis with CC)

– Revised MS–DRG 575 (Skin Graft for Skin Ulcer or Cellulitis without CC/MCC)

– Revised MS–DRG 576 (Skin Graft Except for Skin Ulcer or Cellulitis with MCC)

– Revised MS–DRG 577 (Skin Graft except for Skin Ulcer or Cellulitis with CC)

– Revised MS–DRG 578 (Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC)


MS-DRGs 640 - 642

Revision of titles for:

• MS–DRG 640 (Miscellaneous Disorders of Nutrition, Metabolism, and Fluids and Electrolytes with MCC)

• MS–DRG 641 (Miscellaneous Disorders of Nutrition, Metabolism, and Fluids and Electrolytes without MCC)

• MS–DRG 642 (Inborn and Other Disorders of Metabolism).

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MS-DRGs 619 - 621

• Add new procedure code 43.82 (Laparoscopic vertical (sleeve) gastrectomy) and 43.89 (Other total gastrectomy) to MS-DRG 619 –620 ((O.R. Procedures for Obesity with MCC, with CC, and withoutCC/MCC, respectively)

• Add 43.82 to MCE Edit for Non-Covered Procedures


MDC 15 - (Newborns and Other Neonates With Conditions Originating in the Perinatal Period)

• A change was made to the MS-DRG methodology in FY2011 with regards to a new discharge status.

• This discharge status was not added to MS–DRG 789 (Neonate, Died or Transferred to Another Acute Care Facility

• Adoption of Discharge Status 66 (Discharged/Transferred to Critical Assess Hospital (CAH)) for FY12.

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MS DRGs 981, 982, 983

– No changes are made for FY 2012


MS DRGs 984, 985, 986

– Prostatic procedures are performed and are unrelated to the principal diagnosis


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MS DRGs 987, 988, 989



Updating ICD-9-CM and ICD-10-CM/PCS

• Last major update to occur October 1, 2011 to ICD-9-CM as well as ICD-10-CM and ICD-10-PCS

• Any urgent code updates between September 2011 and March 2013 would be discussed at the Coordination and Maintenance Committeemeetings

– Determine new technology

– Determine new disease (public health)

• Next major update would be to ICD-10-CM and ICD-10-PCS on October 1, 2014

• Coordination and Maintenance Committee will continue to meet twice per year through the transition from ICD-9-CM to ICD-10-CM/PCS.

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Hospital Inpatients

• Increase the number of diagnoses and procedures to 25 diagnoses and 25 procedures for hospital inpatient claims began January 1, 2011 as a result of ICD-10 implementation activities.

• Final version of ICD-10 MS-DRGs to be implemented October 1, 2013 will be subject to National Rulemaking.

• Finalizing proposed clarification of the IPPS recalled device policy to state that the policy applies where ‘‘the hospital received a credit equal to 50 percent or more of the cost of the replacement device,’’ and we will issue instructions to hospitals accordingly.


Cost to Charge Ratio FY12

Group CCR

• Routine Days ................................ 0.525

• Intensive Days .............................. 0.453

• Drugs ............................................ 0.199

• Supplies & Equipment .................. 0.329

• Therapy Services .......................... 0.380

• Laboratory ..................................... 0.146

• Operating Room ........................... 0.251

• Cardiology ..................................... 0.155

• Radiology ...................................... 0.140

• Emergency Room ......................... 0.236

• Blood and Blood Products ............ 0.402

• Other Services .............................. 0.402

• Labor & Delivery ........................... 0.454

• Inhalation Therapy ........................ 0.191

• Anesthesia .................................... 0.116

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New Technologies

• CardioWest™ Temporary Total Artificial Heart System (CardioWest™ TAH-t)

– Approved for FY 2009, continued payment for FY 2010

– Technology that is used as a bridge to heart transplant device for heart transplant-eligible patients with end-stage biventricular failure

– Recent FDA approval

– ICD-9-CM Procedure Code 37.52 with Condition Code 30, and ICD-9-CM Diagnosis Code V70.7 will trigger add-on payment

– Maximum add-on payment: $53,000


New Technologies

• Spiration® IBV® Valve System– Small, temporary, one-way valves placed, via bronchoscopy, into

selected small airways in the lung in order to limit airflow into selected portions of lung tissue that have prolonged air leaks following lobectomy; segmentectomy; or lung volume reduction surgery.

– The valves reduce the amount of air that enters the pleural space– The device has 5 anchors that secure the valve to the airway to help

prevent valve migration – Valves are intended to be removed no later than 6 weeks after

implantation– MS-DRGs 163, 164, and 165 (with procedure code 33.71 or 33.73 in

combination with one of the following procedure codes: 32.22, 32.30, 32.39, 32.41, or 32.49)

– MS-DRGs 199, 200, and 201 with diagnosis 512.1 combination with procedure code 33.71 and 33.73

– Maximum add-on payment of $3,437.50

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New Technologies

• Auto Laser Interstitial Thermal Therapy (LITT)

– AutoLITT™ is a minimally invasive, MRI-guided laser tipped catheter designed to destroy malignant brain tumors with interstitial thermal energy causing immediate coagulation and necrosis of diseased tissue.

– Treatment of Glioblastoma Multiforme

– Add-on payment is applicable to MS-DRGs 25, 26, 27 with procedure code 17.61 (Laser interstitial thermal therapy [LITT] of lesion or tissue of brain under guidance) plus principal diagnosis beginning with 191.xx.

– Maximum add-on payment of $5,300


New Technologies

• AxiaLIF® 2L+TM System

– This technology is an implantable spinal fixation system, delivered through a pre-sacral approach, facilitating spinal fusion through axial stabilization of the anterior lumbar spine at Lumbar vertebrae 4 through Sacral vertebrae 1 (L4–S1).

– Treatment of degeneration of lumbar disc

– Add-on payment is applicable to MS-DRGs 459 and 460 with procedure code 81.08 ((Lumbar and lumbosacral fusion of the anterior column, posterior technique)

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New Technologies

• PerfectCLEAN With Micrillon®

– The manufacturer asserts that PerfectCLEAN is intended to be used to trap and eliminate pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C diff.) and the H1N1 flu virus from surfaces within the hospital (as well as other health care facilities and locations). The applicant asserts that it can trap and remove more than 99.99 percent of bacteria on hard surfaces.

– Elimination of pathogens

– Applicable to 622 different MS-DRGs

– Does not meet the criteria


Quality

• RHQDAPU - Reporting Hospital Quality Data for Annual Payment Update

– Hospital inpatient quality

– High impact for Medicare beneficiary

– Impacted by the Affordable Care Act

– 38 measures for FY12

• PQRI - Physician Quality Reporting Initiative – physician quality

• HOPQDRP - Hospital Outpatient Quality Data Reporting Program –hospital outpatient quality

• Update factor (if submitting quality data) is 2.35.

• Program measures to be collected by Electronic Health Record in FY2015.

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Quality Indicators for FY 2012

Statin prescribed at dischargeAMI-10

Timing of Receipt of Primary Percutaneous Coronary Intervention (PCI)

AMI-8a

Fibrinolytic (thrombolytic) agent received within 30 minutes of hospital arrival

AMI-7a

Beta blocker prescribed at discharge (Data collection suspended 1/1/2012 d/c)

AMI-5

Adult smoking cessation advice/counseling (Retired 1/1/2012)AMI-4

Angiotensin Converting Enzyme Inhibitor (ACE-I) or Angiotensin II Receptor Blocker (ARB) for left ventricular systolic dysfunction Data collection suspended 1/1/2012 d/c)

AMI-3

Aspirin prescribed at dischargeAMI-2

Aspirin at arrival (Data collection suspended 1/1/2012 d/c)AMI-1

Acute Myocardial Infarction (AMI)



Adult smoking cessation advice/counseling (Retired 1/1/2012)

HF-4

Angiotensin Converting Enzyme Inhibitor (ACE-I) or

Angiotensin II Receptor Blocker (ARB) for left ventricular systolic dysfunction

HF-3

Left ventricular function assessmentHF-2

Discharge instructionsHF-1

Heart Failure (HF)

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Influenza vaccination statusPN-7

Appropriate initial antibiotic selectionPN-6

Timing of receipt of initial antibiotic following hospital arrival (Retired 1/1/2012)

PN-5c

Adult smoking cessation advice/counseling (Retired 1/1/2012)

PN-4

Blood culture performed before first antibiotic received in hospital

PN-3b

Pneumococcal vaccination statusPN-2

Pneumonia (PN)



Postoperative Urinary Catheter Removal on Post

Operative Day 1 or 2

SCIP-Infection-9

Surgery Patients with Appropriate Hair Removal (Data collection suspended 1/1/2012)

SCIP-Infection-6

Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose

SCIP-Infection-4

Prophylactic antibiotic selection for surgical patientsSCIP-Infection-2

VTE prophylaxis within 24 hours pre/post surgerySCIP-VTE-2

Venous thromboembolism (VTE) prophylaxis ordered for surgery patients

SCIP-VTE-1

Prophylactic antibiotics discontinued within 24 hours after surgery end time

SCIP-3

Prophylactic antibiotic received within 1 hour prior to surgicalincision

SCIP-1

Surgical Care Improvement Project (SCIP)

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Surgery Patients on a Beta Blocker Prior to Arrival Who Received a Beta Blocker During the Perioperative Period

SCIP-Cardiovascular-2

Perioperative Temperature ManagementSCIP-Infection-10

Surgical Care Improvement Project (SCIP)



Readmission Measure

Survey HCAHPS

Pneumonia 30-Day Risk Standardized Readmission

Measure (Medicare patients)

READ-30-PN

Acute Myocardial Infarction 30-Day Risk

Standardized Readmission Measure (Medicare patients)

READ-30-AMI

Heart Failure 30-Day Risk Standardized Readmission

Measure (Medicare patients)

READ-30-HF

Pneumonia 30-day mortality –Medicare patients

Patients' Experience of Care

MORT-30-PN

Heart Failure 30-day mortality Medicare patientsMORT-30-HF

Acute Myocardial Infarction 30-day mortality –

Medicare patients

MORT-30-AMI

Mortality Measures (Medicare Patients)

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AHRQ Patient Safety Indicators (PSIs), Inpatient Quality Indicators (IQIs) and Composite Measures

Hip fracture mortality rateIQI 19

Abdominal aortic aneurysm (AAA) mortality rate (with or

without volume)

IQI 11

Accidental puncture or lacerationPSI 15

Postoperative wound dehiscencePSI 14

Iatrogenic pneumothorax, adultPSI 06



Participation in a Systematic Clinical Database Registry for Stroke Care

Stroke

Death among surgical inpatients with serious, treatable complications

Participation in a Systematic Database for Cardiac Surgery

Cardiac Surgery

Nursing Sensitive

Mortality for selected medical conditions (composite)

Complication/patient safety for selected indicators (composite)

Mortality for selected surgical procedures (composite) Retired

AHRQ Patient Safety Indicators (PSIs) Inpatient Quality Indicators (IQIs) and Composite Measures

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Quality Measures• Measures for FY13

– Retain 55 measures present for FY12– Add Statins Prescribed at Discharge for AMI patients– Add HAC

• Central Line Associated Blood Stream Infection (CLABSI) (NQF #0139) (begin collection January 1, 2011)

• Measures for FY14– 59 measures projected– Retain FY13 measures

• Retire PN-2 and PN-7– Surgical Site Infection (SSI) (NQF #0299) (begin collection January 1, 2012)– Add two chart based measures

• ED Throughput – Admit Decision Time to ED Departure Time for Admitted Patients (NQF #0497)

• ED Throughput - Median time from emergency department arrival to ED departure for admitted patients (NQF #0495) measures.

– Add two global immunizations• Pneumoccocal Immunization;• Influenza Immunization.


Post-Acute Care Transfer Policy

• Discharge status

– Patients transferred to a nonparticipating acute care facility should use discharge status code 02.

– Patients transferred to critical access hospital should use discharge status code 66.

– An acute care hospital “transfer case” includes a transfer to an acute care hospital that would otherwise be eligible to be paid under the IPPS, but does not have an agreement to participate in the Medicare program, and a new paragraph (b)(4) to state that an acute care hospital “transfer” also includes a transfer to a CAH.

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Take Aways from Today

1.

2.

3.

Thank You

Contact informationLaurie M. Johnson, MS,RHIA, CPC-H; Director, ICD-10 Content Development [email protected]

Education

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