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)


84.84* Insertion or replacement of facet replacement device(s)


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


Ascites 789.59

abdominal NEC 789.59

cancerous (M8000/6) 789.51

malignant (M8000/6) 789.51

pseudochylous 789.59


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


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


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


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


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


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


Long-term (current) drug use V58.69

tamoxifen V58.69

Pneumonia

ventilator associated 999.9

Runny nose 784.99

Scratchy throat 784.99


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


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


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


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


What is the same? Still organized by Pre-MDC DRGs and 25

MDCs


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)


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


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)


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)


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


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)


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)


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)


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)


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


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)


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


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


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


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


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


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


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

Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs

Health & Medicine

Transcript of Fiscal Year 2008 New ICD-9-CM Codes and Introduction to MS-DRGs