2024 IPPS Proposed Rule Details Payment Updates, NTAP & MS-DRG Changes, & More

2024 IPPS Proposed Rule Details Payment Updates, NTAP & MS-DRG Changes, & More

CMS released the 2024 IPPS Proposed Rule on April 10, 2023. The Rule will be published in the Federal Register on May 1, 2023. After comments are received and responses documented, the Final Rule will include the definitive updates, effective October 1, 2023. See the home page for the Proposed Rule for tables and additional information on proposed changes.

2024 IPPS Proposed Rule Fact Sheet Includes Information on Payment Updates

2024 IPPS proposed rule

CMS released a fact sheet that summarizes the 1,525-page Proposed Rule document and includes information on proposed changes to payment and policy for FY 2024. This includes a 2.8% increase in IPPS payments for hospitals that participate in the Quality Reporting Program and are meaningful use EHR users. Here’s a summary of some of the proposed changes.

Social Determinant of Health (SDOH) Codes to Impact Payment

Since IPPS payment is based on the use of hospital resources in the treatment of a patient’s severity of illness, complexity of service, and/or consumption of resources, CMS proposes to change the severity of three ICD-10-CM diagnosis codes describing homelessness from NonCC to CC designation to reflect the higher average resource costs of cases with these diagnosis codes compared to similar cases without these codes. The codes are:

  • Z59.00 (Homelessness, unspecified)
  • Z59.01 (Sheltered homelessness)
  • Z59.02 (Unsheltered homelessness).

If approved, the reporting of these codes will affect the severity level of the MS-DRG.

Changes to the COVID-19 and New Technology Add-on Payment Programs

HHS announced an anticipated end to the COVID-19 Public Health Emergency (PHE) for May 2023. This signals the end of the COVID-19 Treatments Add-on Payments (NCTAP) for eligible discharges during the PHE, which would expire at the end of FY 2023 on September 30, 2023.

Additionally, “to increase transparency and improve the efficiency of the New Technology Add-on Payment (NTAP) program and application process,” the FDA approval deadline is proposed to be moved from July 1 to May 1 beginning in FY 2025, with applicants who are not already FDA authorized required to have an active and complete application request at the time of submission of the NTAP application (CMS, 2023). This would allow for a more complete analysis of the NTAP applications.

Changes to MS-DRGs Proposed for FY 2024

Unlike last year when no new MS-DRGs were implemented, this year’s Rule includes proposals for changes in MS-DRGs, with the deletion and restructuring of some MS-DRGs and the addition of 15 new MS-DRGs. These include new MS-DRGs for Coronary Intravascular Lithotripsy, changes to MS-DRGs for appendix procedures, and Ultrasound Accelerated and other Thrombolysis for Peripheral Vascular Structures and with a diagnosis of Pulmonary Embolism among other proposed additions.

More information about these proposed changes can be found within the Rule. The comprehensive list of MS-DRGs includes the proposed additions/deletions in table 5, which is available for download from the home page for the Proposed Rule.

Proposed New Diagnosis and Procedure Codes

As always, the proposed new ICD-10-CM diagnosis and ICD-10-PCS procedure codes are listed as part of the Proposed Rule in tables 6A and 6B, respectively. New diagnosis codes include expansion of codes for Parkinson’s disease, chronic migraine, appendicitis, pathological fractures of the pelvis, and many other codes. The SDOH codes that went into effect on April 1, 2023, are also listed in table 6A.

ICD-10-PCS procedure codes implemented on April 1, 2023, are included in Table 6B, along with other new PCS codes. It is anticipated that additional PCS codes discussed at the March 2023 Coordination and Maintenance Committee will be approved, which were not available for publication in the Proposed Rule. Additional approved codes will appear in Table 6B in the Final Rule for implementation on October 1, 2023.

Also listed in the tables are invalid diagnosis and procedure codes and additions and deletions to the CC Exclusion, MCC and CC list based on the proposed codes.

More Details in the 2024 IPPS Proposed Rule

The Proposed Rule contains many other details and provisions for FY 2024. Comments on the Proposed Rule will be accepted until June 9, 2023, with the Final Rule released later in the summer and effective October 1, 2023. Look for the YES presentations on the FY 2024 changes for ICD-10-CM and ICD-10-PCS codes, as well as updates to the IPPS and MS-DRGs as details become available. Check out our ICD-10 Coding Guidelines Resource Center for the latest updates.

Teri Jorwic

Contract Educator, MPH, RHIA, CCS, CCS-P, FAHIMA
2024 IPPS proposed rule

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