HCPro, JustCoding Inpatient - 2019 Issue 24 (June)
FY 2020 IPPS proposed rule: Summary of proposed changes impacting MS-DRGs, ICD-10-CM/PCS codes
June 11th, 2019
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Article Overview
This article summarizes proposed FY 2020 IPPS changes that affect hospital inpatient coding and grouping logic. It is aimed at coders, CDI professionals, DRG analysts, and reimbursement teams who need a high-level view of upcoming updates to MS-DRGs, ICD-10-CM, and ICD-10-PCS across several body systems and severity categories. The discussion spans diagnosis and procedure reassignments, DRG title and structure changes, OR/non-OR procedure status changes, and proposed CC/MCC designation revisions.
Why This Topic Matters
These proposed changes can affect inpatient DRG assignment, severity level reporting, and related reimbursement and quality-impacting classifications. Reviewing them helps organizations prepare for code set and grouper logic updates before they take effect.
Article Sections
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MDC 1, Diseases and Disorders of the Nervous System
Discusses proposed MS-DRG grouping changes related to nervous system procedures and related procedure-code removals.
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MDC 4, Diseases and Disorders of the Respiratory System
Covers proposed reassignment of respiratory-system diagnoses and related DRG title updates.
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MDC 5, Diseases and Disorders of the Circulatory System
Reviews proposed changes involving cardiovascular procedures, cardiac valve cases, pacemaker-related grouping, and related DRG structure updates.
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MDC 8, Diseases and Disorders of the Musculoskeletal System and Connective Tissue
Summarizes proposed changes affecting musculoskeletal diagnoses, spinal curvature cases, and knee-related infection groupings.
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MDC 11, Diseases and Disorders of the Kidney and Urinary Tract
Addresses proposed deletion and revision of urinary stone DRGs and related grouping logic changes.
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MDC 12, Diseases and Disorders of the Male Reproductive System
Covers proposed reassignment of imaging-related diagnosis codes into male reproductive system DRGs.
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MDC 14, Pregnancy Childbirth and the Puerperium
Summarizes a proposed pregnancy-related diagnosis code status change within the obstetric grouping framework.
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MDC 23, Factors Influencing Health Status and Other Contacts with Health Services
Describes a proposed reassignment of an abnormal imaging finding into signs-and-symptoms DRGs.
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Additional MS-DRG changes
Reviews miscellaneous proposed DRG reassignments involving tumors, dialysis catheter issues, transplant-related procedures, gastrointestinal procedures, and other inpatient grouping updates.
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Proposed additions for diagnosis and procedure codes to MDCs
Covers proposed additions and reassignments for specific diagnosis-procedure combinations across several MDCs.
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Proposed OR to non-OR procedures
Summarizes procedure status changes proposed to move selected ICD-10-PCS procedures out of OR classification.
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Proposed non-OR to OR procedures
Summarizes procedure status changes proposed to move selected procedures into OR classification.
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CC/MCC proposed changes
Reviews proposed severity designation changes for diagnosis codes, including broad CC and MCC redistribution trends.
What You Will Learn
- How the FY 2020 IPPS proposed rule affects inpatient DRG grouping
- Which major diagnostic categories are addressed in the summary
- What types of ICD-10-CM and ICD-10-PCS changes are proposed
- How proposed CC/MCC severity revisions are organized
- Which broad areas of inpatient reimbursement logic are being updated
Who Should Read This
- Inpatient coders
- CDI specialists
- DRG analysts
- Hospital reimbursement teams
- Coding auditors
- Revenue integrity professionals
Codes Discussed
Code Ranges Discussed
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