2018 IPPS final rule: Answering your questions

Why This Topic Matters

The rule changes discussed can affect inpatient diagnosis sequencing, procedure classification, DRG assignment, and overall payment-related workflow. Understanding the broad areas of change helps coding and CDI teams prepare for implementation and identify records that may be affected.

Article Sections

1. Introduction

   Overview of the rule year, implementation timing, and the purpose of the Q&A format for coders and CDI specialists.

2. COPD, pneumonia, and sequencing guidance

   Discussion of diagnosis sequencing language in ICD-10-CM and how updated terminology affects interpretation of related guidance.

3. Total ankle procedure and DRG changes

   Summary of how inpatient grouping changes affect certain lower-extremity replacement cases under the final rule.

4. New Type II MI codes and DRG assignment

   Explanation of how new myocardial infarction classification updates fit into existing DRG groupings.

5. Skin excisions, debridement, and surgical DRGs

   Review of changes affecting skin and breast excision coding and how procedure grouping has shifted for selected DRGs.

6. TIA, stroke, thrombolytic therapy, and DRG changes

   Discussion of stroke-related diagnosis categories, thrombolytic therapy, and the related DRG assignments under the new rule.

7. Spinal fusion code reclassification and grouper logic

   Overview of revisions affecting spinal fusion classification and the distinction between coding and grouper logic issues.

8. Substance use, remission, and coding guidance

   Coverage of updated substance-related diagnosis classifications and the documentation concepts associated with remission.

9. Heart failure and new diagnosis codes

   Summary of new heart failure diagnosis codes and their classification status in the updated system.

10. Other notable updates

    Brief mention of additional diagnosis and procedure code updates affecting diabetes and intestinal adhesions.