HCPro, JustCoding Inpatient - 2019 Issue 26 (June)
2020 IPPS proposed rule brings potential MS-DRG changes
June 25th, 2019
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Article Overview
This article reviews selected FY 2020 IPPS proposed-rule updates that affect MS-DRG assignment for inpatient hospital claims. It focuses on broad categories of CMS analysis and proposed restructuring, including severity-level review of diagnosis codes, refinement of unrelated OR DRG assignments, and updates tied to ICD-10-CM and ICD-10-PCS data. The piece is useful for inpatient coders, CDI professionals, and hospital reimbursement staff who want a high-level view of where MS-DRG policy may shift.
Why This Topic Matters
MS-DRG changes can alter inpatient case grouping and reimbursement, so awareness of proposed CMS updates helps coding and reimbursement teams prepare for annual rule changes and assess operational impact.
Article Sections
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Changes to MCC and CC designation
Explains the scope of CMS’ review of diagnosis severity designations and summarizes the general types of proposed updates under consideration. It also describes the data-driven approach used in the analysis.
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Review of ‘Unrelated OR DRG’ assignments
Discusses CMS’ annual review of certain unrelated OR DRG assignments and the broader categories of diagnosis-procedure combinations being examined. It highlights the role of ICD-10-coded data in identifying potential reclassification opportunities.
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Below are a few other proposed MS-DRG changes of interest
Summarizes additional proposed MS-DRG updates involving selected procedure groups and category-level restructuring. The section covers several distinct areas of surgical and cardiovascular DRG reconsideration.
What You Will Learn
- How CMS is using ICD-10 data to review MS-DRG assignment changes
- What kinds of diagnosis severity designations are being reevaluated
- How unrelated OR DRG assignments are reviewed at a high level
- Which broad procedure categories are included in the proposed DRG changes
- How selected ICD-10-CM and ICD-10-PCS updates can affect inpatient grouping
Who Should Read This
- Inpatient hospital coders
- CDI specialists
- Hospital reimbursement analysts
- Case management and revenue cycle staff
- Coding educators and auditors
Codes Discussed
Code Ranges Discussed
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