Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs
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Transcript of Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs
Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs
Barry Libman, RHIA, CCS, CCS-P
President
Barry Libman Inc.
Inpatient PPS, FY 2008
Agenda: New codes New Guidelines Changes to the addenda MS-DRGs Get CEUs !
Federal Register
Federal Register / Vol. 72, No. 162 Wednesday, August 22, 2007, pp. 47130 - 48175
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-3820.pdf
Codes Changes for FY 2007
Revisions and new codes will be implemented for discharges on or after October 1, 2007
122 New Diagnosis Codes
20 New V Codes
39 New Procedure Codes
Infectious and Parasitic Diseases
040.41 Infant botulism CC 040.42 Wound botulism CC
058.10 Roseola infantum, unspecified 058.11 … due to human herpesvirus 6 058.12 … due to human herpesvirus 7
Infectious and Parasitic Diseases
058.21 Human herpesvirus 6 encephalitis MCC
058.29 Other human herpesvirus encephalitis MCC
058.81 Human herpesvirus 6 infection 058.82 Human herpesvirus 7 infection 058.89 Other human herpesvirus infection
079.83 Parvovirus B19 CC
Neoplasms
200.30-38 Marginal zone lymphoma CC 200.40-48 Mantle cell lymphoma CC 200.50-58 Primary central nervous system
lymphoma CC 200.60-68 Anaplastic large cell lymphoma CC 200.70-78 Large cell lymphoma CC
202.70-78 Peripheral T cell lymphoma CC
Neoplasms
233.30 Carcinoma in situ, unspecified female genital organ
233.31 … vagina 233.32 … vulva 233.39 … other female genital organ
Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders 255.41 Glucocorticoid deficiency CC 255.42 Mineralocorticoid deficiency CC
258.01 Multiple endocrine neoplasia [MEN] type I
258.02 … type IIA 258.03 … type IIB
Diseases of the Blood and Blood-Forming Organs 284.81 Red cell aplasia (acquired)(adult)(with
thymoma) MCC 284.89 Other specified aplastic anemias MCC
288.66 Bandemia
Mental Disorders
315.34 Speech and language developmental delay due to hearing loss
Diseases of the Nervous System and Sense Organs 331.5 Idiopathic normal pressure
hydrocephalus (INPH) CC
359.21 Myotonic muscular dystrophy 359.22 … congenita 359.23 … chondrodystrophy 359.24 Drug induced myotonia 359.29 Other specified myotonic disorder
364.81 Floppy iris syndrome 364.89 Other disorders of iris and ciliary body
Diseases of the Nervous System and Sense Organs 388.45 Acquired auditory processing disorder 389.05 Conductive hearing loss, unilateral 389.06 … bilateral 389.13 Neural hearing loss, unilateral 389.17 Sensory hearing loss, unilateral 389.20 Mixed hearing loss, unspecified 389.21 … unilateral 389.22 … bilateral
Diseases of Circulatory System
414.2 Chronic total occlusion of coronary artery
415.12 Septic pulmonary embolism MCC
423.3 Cardiac tamponade CC
440.4 Chronic total occlusion of artery of the extremities
449 Septic arterial embolism CC
Diseases of the Respiratory System
488 Influenza due to identified avian influenza virus Notes on use of code 488:
Code only confirmed cases of avian influenza. (This is an exception to the hospital inpatient guidelines for coding uncertain diagnoses. )
“Confirmation” does not require documentation of positive laboratory testing
Coding should be based on the provider’s diagnostic statement
If the provider records “suspected or possible or probable avian influenza,” the appropriate influenza code from category 487 should be assigned.
Similar to coding of HIV/AIDS
Diseases of the Digestive System
525.71 Osseointegration failure of dental implant
525.72 Post-osseointegration biological failure of dental implant
525.73 … mechanical failure … 525.79 Other endosseous dental implant
failure
569.43 Anal sphincter tear (healed) (old)
Diseases of the Genitourinary System
624.01 Vulvar intraepithelial neoplasia I [VIN I] 624.02 … neoplasia II [VIN II] 624.09 Other dystrophy of vulva
Complications of Pregnancy, Childbirth, and the Puerperium 664.60 Anal sphincter tear complicating
delivery, not associated with third-degree perineal laceration, unspecified as to episode of care or not applicable
664.61 … delivered, w/ or w/out mention of antepartum condition CC
664.64 … postpartum condition or complication CC
Diseases of the Musculoskeletal System and Connective Tissue 733.45 Aseptic necrosis of bone, jaw CC
Symptoms, Signs, and Ill-Defined Conditions 787.20 Dysphagia, unspecified 787.21 … oral phase 787.22 … oropharyngeal phase 787.23 … pharyngeal phase 787.24 … pharyngoesophageal phase 787.29 Other dysphagia
789.51 Malignant ascites CC 789.59 Other ascites CC
Injury and Poisoning
999.31 Infection due to central venous catheter CC
999.39 Infection following other infusion, injection, transfusion, or vaccination CC
Please note: These codes were not included in the proposed rule but will be implemented on October 1, 2007.
V Codes
Factors influencing health-status and contact with health service
20 new V Codes
V Codes
V12.53 Personal history of sudden cardiac arrest
V12.54 Personal history of transient ischemic attack (TIA), and cerebral infarction w/out residual deficits
V13.22 Personal history of cervical dysplasia
V Codes
V16.52 Family history of malignant neoplasm, bladder
V17.41 Family history of sudden cardiac death (SCD)
V17.49 Family history of other cardiovascular diseases
V18.11 Family history of multiple endocrine neoplasia [MEN] syndrome
V18.19 Family history of other endocrine and metabolic diseases
V Codes
V25.04 Counseling and instruction in natural family planning to avoid pregnancy
V26.41 Procreative counseling and advice using natural family planning
V26.49 Other procreative management, counseling and advice
V26.81 Encounter for assisted reproductive fertility procedure cycle
V26.89 Other specified procreative management
V Codes
V49.85 Dual sensory impairment
V68.01 Disability examination V68.09 Other issue of medical certificates
V72.12 Encounter for hearing conservation and treatment
V Codes
V73.81 Special screening examination, Human papillomavirus (HPV)
V84.81 Genetic susceptibility to multiple endocrine neoplasia [MEN]
V84.89 … other disease
Procedure Codes
39 new Procedure Codes
Please note: Procedure Codes marked with an asterisk (*) were not included in the proposed rule but will be implemented on October 1, 2007.
Procedure Codes
00.19 Disruption of blood brain barrier via infusion [BBBD]
00.94* Intra-operative neurophysiologic monitoring
01.10 Intracranial pressure monitoring 01.16 Intracranial oxygen monitoring 01.17 Brain temperature monitoring
Procedure Codes
07.83* Thoracoscopic partial excision of thymus
07.84* … total excision of thymus 07.95* … incision of thymus 07.98* Other and unspecified thoracoscopic
operations on thymus
Procedure Codes
32.20* Thoracoscopic excision of lesion or tissue of lung
32.30* … segmental resection of lung 32.39* Other and unspecified segmental
resection of lung 32.41 Thoracoscopic lobectomy of lung 32.49 Other lobectomy of lung
Procedure Codes
32.50* Thoracoscopic pneumonectomy 32.59* Other and unspecified pneumonectomy 33.20 Thoracoscopic lung biopsy 34.06 … drainage of pleural cavity 34.20 … pleural biopsy 34.52 … decortication
Procedure Codes
50.13* Transjugular liver biopsy 50.14* Laparoscopic liver biopsy
Procedure Codes
70.53 Repair of cystocele and rectocele with graft or prosthesis
70.54 Repair of cystocele … 70.55 Repair of rectocele …
70.63 Vaginal construction with graft or prosthesis
70.64 Vaginal reconstruction … 70.78 Vaginal suspension and fixation …
Procedure Codes
70.93 Other operations on cul-de-sac with graft or prosthesis
70.94 Insertion of biological graft 70.95 Insertion of synthetic graft or prosthesis
Procedure Codes
84.80* Insertion or replacement of interspinous process device(s)
84.81* Revision of …
84.82* Insertion or replacement of pedicle-based dynamic stabilization device(s)
84.83* Revision of …
84.84* Insertion or replacement of facet replacement device(s)
84.85* Revision of …
Procedure Codes
88.59 Intra-operative fluorescence vascular angiography
92.41* Intra-operative electron radiation therapy
Guidelines
ICD-9-CM Official Guidelines for Coding and Reporting, Effective October 1, 2007
www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf
Addenda to the ICD-9-CM Index
Accident, accidental - see also condition cerebrovascular (current) (CVA) (see also Disease, cerebrovascular, acute) 434.91
aborted 434.91 healed or old V12.54
(See Coding Clinic Q3, 2007)
Anemia postoperative
due to (acute) blood loss 285.1 chronic blood loss 280.0
Addenda to the ICD-9-CM Index
Ascites 789.59
abdominal NEC 789.59
cancerous (M8000/6) 789.51
malignant (M8000/6) 789.51
pseudochylous 789.59
Addenda to the ICD-9-CM Index
CIDP (chronic inflammatory demyelinating polyneuropathy) 357.81
Congestion, congestive (chronic) (passive) chest 786.9 lung 786.9 nose 478.19
Crush, crushed, crushing (injury) 929.9 with
fracture - see Fracture, by site
Addenda to the ICD-9-CM Index
Death
cardiac (sudden) (SCD) - see Disease, heart code to underlying condition
Deficit
neurologic NEC 781.99
ischemic
reversible (RIND) 434.91
history of (personal) V12.54
prolonged (PRIND) 434.91
history of (personal) V12.54
Addenda to the ICD-9-CM Index
Disease, diseased - see also Syndrome
liver 573.9
end stage NEC 572.8
due to hepatitis - see Hepatitis
Feeling of foreign body in throat 784.99
Foreign body
feeling of, in throat 784.99
throat, feeling of 784.99
Addenda to the ICD-9-CM Index
Fluid peritoneal cavity 789.59
malignant 789.51
Findings, abnormal, without diagnosis (examination) (laboratory test) 796.4
cholesterol 272.9 high 272.0
with high triglycerides 272.2
Addenda to the ICD-9-CM Index
History (personal) of
family
myocardial infarction V17.3
sudden cardiac death (SCD) V17.41
personal
sudden
cardiac
arrest V12.53
death (successfully resuscitated) V12.53
Addenda to the ICD-9-CM Index
Neoplasia
vaginal intraepithelial I [VAIN I] 623.0
vaginal intraepithelial II [VAIN II] 623.0
vaginal intraepithelial III [VAIN III] 233.31
vulvar intraepithelial I [VIN I] 624.01
vulvar intraepithelial II [VIN II] 624.02
vulvar intraepithelial III [VIN III] 233.32
Addenda to the ICD-9-CM Index
Long-term (current) drug use V58.69
tamoxifen V58.69
Pneumonia
ventilator associated 999.9
Runny nose 784.99
Scratchy throat 784.99
Addenda to the ICD-9-CM Index
Status (post) sex reassignment surgery (see also Tran-sexualism) 302.50
Stenosis (cicatricial) - see also Stricture artery NEC (see also Arteriosclerosis) 447.1
extremities 440.20
Stroke 434.91 in evolution 434.91
Medicare Severity DRGs: MS-DRGs
Effective for discharges beginning 10/1/07 Why a severity adjusted classification system?
ability to differentiate cases based on severity of illness and resource consumption
The RAND report focuses on the following criteria: “sensitivity to severity” How well each classification system explains variation in
resource use Whether the groupings are manageable, administratively
feasible and understandable Payment accuracy
Medicare Severity DRGs: MS-DRGs
What is the same? For Payment of Acute Hospital Inpatient
Discharges Exempt:
Critical Access Hospitals Rehab Hospitals and units Long Term Acute Care Hospitals Psychiatric Hospitals and Units Children’s Hospitals Cancer Hospitals
Medicare Severity DRGs: MS-DRGs
What is the same? Admissions that are medically necessary are
paid for under Medicare Part A by DRG payment methodology
Each MS-DRG has been assigned a payment weight based on average resources used to treat Medicare patients
Post acute care transfer payment policy
Medicare Severity DRGs: MS-DRGs
What is the same? The basic grouping process is the same Principal diagnosis and up to 8 additional
diagnoses ( ICD-9-CM) Up to 6 procedure codes ( ICD-9-CM) Gender and discharge status still affect some
DRG assignments
Medicare Severity DRGs: MS-DRGs
What is the same? Still organized by Pre-MDC DRGs and 25
MDCs
Medicare Severity DRGs: MS-DRGs
What is different? Complete restructuring of the DRG system
(745 DRGs in FY 2008 replacing 538 in FY 2007)
MS-DRG categories split by With Major CC With CC Without CC or MCC (some exceptions)
Medicare Severity DRGs: MS-DRGs
What is different?
Addition of a Major CC List (1584 MCCs) http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?
filterType=none&filterByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS1201733&int
NumPerPage=10
Revision of the CC list (3343 CCs) http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?
filterType=none&filterByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS1201734&intNumPerPage=10
Medicare Severity DRGs: MS-DRGs
Simple Pneumonia and Pleurisy
DRG 193 w/ Major CC wt.1.2505
DRG 194 w/ CC wt. 1.0235 (FY 07 wt. 1.0376)
DRG 195 (w/out CC or MCC) wt. .8398 (FY 07 wt. .6148)
Medicare Severity DRGs: MS-DRGs
Major small and large bowel procedures
DRG 329 w/ Major CC wt. 4.5059 (FY 07 wt. 4.3425)
DRG 330 w/ CC wt. 2.8935 (FY 07 wt. 2.6978)
DRG 331 w/out CC or MCC wt. 1.8415 (FY 07 wt.1.4364)
Medicare Severity DRGs: MS-DRGs
Percutaneous Cardiovascular procedures DRG 246 w/ drug-eluting stent w/ MCC or 4+ vessels or
stents wt. 2.9046 (FY 07 wt. 2.7610)
DRG 247 w/ drug-eluting stent w/o MCC wt. 2.1255 (FY 07 wt. 2.0814)
4+ vessels or stents 36.07 and any of the following procedure combinations
00.43 procedure 4+ vessels and 00.66 procedure PTCA or coronary atherectomy
00.48 insertion 4+ vascular stents and 00.66 procedure PTCA or coronary atherectomy
Medicare Severity DRGs: MS-DRGs
Nutritional and Metabolic Disorders (e.g., dehydration)
DRG 640 w/ Major CC wt. .9793 (FY 07 wt. .8334)
DRG 641 w/out CC or MCC wt. .7248 (FY07 wt. .5090)
Syncope and Collapse DRG 312 wt. .7197
(FY 07 wt. .5024 or wt. .7627)
Medicare Severity DRGs: MS-DRGs
Congestive Heart Failure 291 Heart failure and shock w/ MCC wt. 1.2585
(FY 07 wt. 1.0485)
292 Heart failure and shock w/ CC wt. 1.0134 (FY 07 wt. 1.0485)
293 Heart failure and shock w/out CC/MCC wt. 0.8765 (FY 07 wt. 1.0485)
Medicare Severity DRGs: MS-DRGs
Sepsis 870 Septicemia w/ MV 96+ hours wt. 5.7579
(FY 07 wt. 5.9388 or 1.8734)
871 Septicemia w/out MV 96+ hours w/ MCC wt. 1.7484 (FY 07 wt. 1.5953)
872 Septicemia w/out MV 96+ hours w/out MCC wt. 1.3783 (FY 07 wt. 1.5953)
Medicare Severity DRGs: MS-DRGs
Respiratory Failure 207 Respiratory system diagnosis w/
ventilator support 96+ hours wt. 5.1231 (FY 07 wt. 5.2294)
208 Respiratory system diagnosis w/ ventilator support <96 hours wt. 2.2463 (FY 07 wt. 2.3335)
Medicare Severity DRGs: MS-DRGs
Selected Major CCs Quadriplegia Severe malnutrition Toxic encephalopathy Acute systolic congestive heart failure Acute diastolic congestive heart failure Pneumonia Acute renal failure End stage renal disease Decubitus ulcers Cardiogenic/septic shock Fractures/burns Sepsis/severe sepsis
Medicare Severity DRGs: MS-DRGs
The following are Major CCs only for patients discharged alive, otherwise they are assigned as a non CC.
Diagnoses codes 427.41 (Ventricular fibrillation) 427.5 (Cardiac arrest) 785.51 (Cardiogenic shock) 785.59 (Other shock w/out mention of trauma) 799.1 (Respiratory arrest)
Medicare Severity DRGs: MS-DRGs
A few CCs to keep in mind 427.0 Paroxysmal supraventricular tachycardia 427.1 Paroxysmal ventricular tachycardia 427.32 Atrial Flutter 438.2x Late effects of CVA-Hemiplegia 599.0 Urinary tract infection
Some Additions to the CC list V55.1 Attention to Gastrostomy V62.84 Suicidal ideation V85.0 Body Mass Index less than 19, adult V85.4 Body Mass Index 40 and over, adult
Medicare Severity DRGs: MS-DRGs
No longer CCs (not a complete list) 135 Sarcoidosis 138 Late effect acute polio 250.01 DMI w/out cmp nt st uncntrl 250.02 DMII w/out cmp uncntrld 250.03 DMI w/out cmp uncntrld 263.0 Malnutrition mod degree 263.1 Malnutrition mild degree 276.50 Volume depletion NOS 276.51 Dehydration 276.52 Hypovolemia 276.6 Fluid overload 276.7 Hyperpotassemia
Medicare Severity DRGs: MS-DRGs
No longer CCs (not a complete list) 340 Multiple sclerosis 358.00 Myesthenia gravis w/out acute exacerbation 413.9 Angina pectoris NEC/NOS 424.0 Mitral valve disorder 424.1 Aortic valve disorder 427.31 Atrial fibrillation 428.0 CHF NOS 491.20 Obst chr bronc w/out exacerbation 492.8 Emphysema NEC 496 Chronic airway obstruct NEC 515 Postinflamatory pulmonary fibrosis
Medicare Severity DRGs: MS-DRGs
No longer CCs (not a complete list) 536.40 Gastrostomy complication NOS 536.49 Gastrostomy complication NEC 571.2 Alcoholic cirrhosis liver 571.49 Chronic hepatitis NEC 571.5 Cirrhosis of liver NOS 571.6 Biliary cirrhosis 573.3 Hepatitis NOS 585.1 Chronic Kidney disease stage I 585.2 Chronic Kidney disease stage II 585.3 Chronic Kidney disease stage III 585.9 Chronic Kidney disease NOS 599.7 Hematuria
Medicare Severity DRGs: MS-DRGs
No longer CCs (not a complete list) 696.0 Psoriatic arthropathy 710.0 Systemic lupus erythematosus 710.1 Systemic sclerosis 722.80 Postlaminectomy syndrome NOS 722.81 Postlaminectomy syndrome-cervical 722.82 Postlaminectomy syndrome-thoracic 722.83 Postlaminectomy syndrome-lumbar 780.39 Convulsions NEC 788.20 Retention urine NOS 997.5 Surgical complication-urinary tract 998.89 Other specific complication of procedure NEC V42.2 Heart valve transplant V45.1 Renal dialysis status
Opportunities for Documentation ImprovementMalnutrition 260 Kwashiorkor MCC 261 Nutritional marasmus MCC 262 Other severe protein-calorie malnutrition MCC
263.2 Arrested development following protein-calorie malnutrition CC
263.8 Other protein-calorie malnutrition CC 263.9 Unspecified protein-calorie malnutrition CC
263.0 Malnutrition of Moderate degree Not a CC 263.1 Malnutrition of Mild degree Not a CC
Opportunities for Documentation Improvement
Congestive Heart Failure, Major CCs 428.21 Acute systolic heart failure MCC 428.23 Acute on chronic systolic heart failure MCC 428.31 Acute diastolic heart failure MCC 428.33 Acute on chronic diastolic heart failure MCC 428.41 Acute combined systolic and diastolic heart
failure MCC 428.43 Acute on chronic combined systolic and
diastolic heart failure MCC
Opportunities for Documentation Improvement
Congestive Heart Failure, CCs 428.1 Left heart failure CC 428.20 Unspecified systolic heart failure CC 428.22 Chronic systolic heart failure CC 428.30 Unspecified diastolic heart failure CC 428.32 Chronic diastolic heart failure CC 428.40 Unspecified combined systolic and diastolic
heart failure CC 428.42 Chronic combined systolic and diastolic heart
failure CC
428.0 Congestive heart failure unspecified Not a CC 428.9 Heart Failure Unspecified Not a CC
Opportunities for Documentation Improvement
Coding Clinic 2002 Q2
For Inpatient Discharges, requires the attending physician to confirm the results of diagnostic testing in the progress notes or discharge summary. (Do not code from radiology or laboratory reports.)
Coding Clinic 2004 Q1
For Inpatient Discharges, documentation from a physician other than the attending may be used for coding purposes as long as the documentation does not conflict with information written by the attending physician.
Resources
Federal Register http://a257.g.akamaitech.net/7/257/2422/01jan20071800/
edocket.access.gpo.gov/2007/pdf/07-3820.pdf ICD-9-CM Official Guidelines for Coding and
Reporting, Effective October 1, 2007 www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf
Major CC List http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/
itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS1201733&intNumPerPage=10
CC list http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/
itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2&sortOrder=ascending&itemID=CMS1201734&intNumPerPage=10
Resources
Crosswalk V24.0 to V25.0 http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?
filterType=none&filterByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS1198678&intNumPerPage=10
V25.0 DRGs and Weights http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?
filterType=none&filterByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS1198553&intNumPerPage=10
Ingenix DRG Calculator https://www.hospitalbenchmarks.com/DRGCalculator.aspx
3M MS-DRG V 25.0 Definitions Manual
Barry Libman Inc., Resources www.barrylibmaninc.com
Recommendations
Review the lists of new DRGS, major CCs and CCs
Test the new encoders Practice, Practice, Practice
Questions?
Barry Libman, RHIA, CCS, CCS-P
President, Barry Libman Inc.
978-369-7180
Email: [email protected]
www.barrylibmaninc.com