Review the 2021 IPPS Proposed Rule’s MS-DRG & Other ICD-10 Coding Updates

Review the 2021 IPPS Proposed Rule’s MS-DRG & Other ICD-10 Coding Updates


The 2021 Proposed Rule for Inpatient Prospective Payment System (IPPS) was released on May 11, and will be published in the May 29, 2020, Federal Register (2020). Provisions in the rule increase the Medicare IPPS rate for hospitals that report quality data and are meaningful users of EHRs by approximately 3.1%, resulting in an increase of $2.07 billion in spending. With other adjustments, the overall payment increase for inpatient hospitals will be around 1.6%.

The Proposed Rule adjusts the payment rates, MS-DRGs, and other provisions. Among the changes is a proposal for a new MS-DRG code for Chimeric Antigen Receptor (CAR) T-Cell Therapies. Current hospital rates for CAR-T cases are paid at the same rate as bone marrow transplants, with additional payments via the new technology add-on payments, but these add-on payments expire in FY 2021. Other new MS-DRGs are proposed, as well as changes in both diagnosis and procedure codes that group to MS-DRGs. CMS is also proposing changes for the new technology add-on payment (NTAP) for certain antimicrobial products that meet the alternative pathway criteria that would allow these add-on payments to take effect before FDA approval.

IPPSThe Proposed Rule also includes new ICD-10-CM and ICD-10-PCS codes. Though the codes are published in the proposed and final rule, they are not subject to comment. The majority of the more than 400 new diagnosis codes include expansions of categories and subcategories. There are new codes for sickle cell and other types of anemia and cytokine release, a syndrome that sometimes occurs after CAR-T therapy. This syndrome has also recently been associated with COVID-19 cases. Other changes include expanded substance abuse codes involving withdrawal, corneal dystrophies, and complications of corneal transplants. Specific codes for synthetic narcotics fentanyl and tramadol poisoning are included, as well as adverse effects and underdosing of these and other synthetic narcotics. These more specific codes will supply data for the fight against opioid addiction. There are additions to the External Cause codes, particularly for scooter accidents. The category U07 codes for Vaping-related disorder and COVID-19 that were effective on April 1, 2020, are also included. See Table 6A appended to the Proposed Rule for a complete list of the proposed ICD-10-CM diagnosis codes (CMS, 2020).

There are more than 200 new ICD-10-PCS codes that include Fragmentation procedures in the heart and great vessels, and new code tables for Fragmentation of the upper and lower arteries and veins, with the addition of a qualifier for ultrasonic. New approach values for via natural or artificial opening and via natural or artificial opening endoscopic were added for Drainage of the pelvic cavity in code table 0W9. A new Measurement code for musculoskeletal compartment pressure is added. A new code table, BF5, is added for Other imaging in the Hepatobiliary System and Pancreas. Many new codes are added in the Radiation Therapy section for Brachytherapy utilizing the Cesium-131 isotope. Six new Section X codes are included, all for Introduction of specified substances. See Table 6B for a full list of the latest ICD-10-PCS codes (CMS, 2020). There are lists of additions and deletions to the CC exclusion, CC, and MCC lists due to the code updates.

The IPPS Proposed Rule includes additional information on issues such as building on price transparency by publishing hospital rates by MS-DRGs, inpatient quality reporting program, and graduate education funding. See the full 1600-page Proposed Rule for more details (Federal Register, 2020). CMS is accepting comments on the IPPS Proposed Rule until July 10. 2020. The IPPS Final Rule will be released later in the summer, with changes effective on October 1, 2020. Stay tuned to the YES Blog for additional updates on the Inpatient Prospective Payment System Final Rule.

Need to catch up on the ICD-10 IPPS and MS-DRG FY2020 updates? Enroll in our ICD-10 IPPS and MS-DRG 10-1-19 Updates FY2020 Webinar! Once the 2021 IPPS Final Rule is issued, we will release an ICD-10 IPPS and MS-DRG 10-1-20 FY2021 Webinar later in the year.

Teri Jorwic

Contract Educator, MPH, RHIA, CCS, CCS-P, FAHIMA

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