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Coding Updates from IPPS 2023 [PODCAST]

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The Hospital Finance Podcast

In this episode, we’re pleased to welcome Kristen Eglintine, Coding Analyst Supervisor at BESLER, to discuss the coding updates from the IPPS 2023 Final Rule.

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Highlights of this episode include:

  • COVID-19, still impacting healthcare?
  • ICD-10-CM changes that coders can expect to see in October
  • Changes to procedure coding
  • MS-DRG
  • Tips on preparing for the new coding changes

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Kristen Eglintine, Coding Analyst Supervisor here at BESLER, the first of many visits, I’m sure. Today, we’re going to discuss coding updates from the fiscal year 2023 IPPS Final Rule, which CMS published on August 1st, 2022. All coding changes are effective October 1st, 2022. Thank you for joining us today, Kristen.

Kristen Eglintine: Thank you. I’m very excited to be here, and I appreciate this opportunity.

Kelly: Great. Well, let’s jump in today. Before we begin, let me ask you, is COVID-19 still impacting healthcare?

Kristen: Yes. Great question. It’s worth mentioning that we are still in a public health emergency. This was issued by the US Department of Health and Human Services. It’s been in place since January 27th of 2020, and has been renewed throughout the entire pandemic. The latest extension is effective through October 13th. And it’s important to note this because it has affected decisions made by CMS, which are published in the 2023 IPPS Final Rule. And you will see that as we go through.

Kelly: And there are many components of the IPPS Final Rule. As a note, we discussed financial changes in a previous webinar. This was your 2023 IPPS Final Rule summary that we presented on August 10th of this year. We also had a podcast go along with that. It’s on our website now, if you’re interested. But Kristen, can you touch on a couple of ICD-10-CM changes that coders can expect to see in October?

Kristen: So, the 2023 ICD-10-CM update is rather extensive. I will give you a brief overview, but it is a big one this year. It includes 1,176 new codes. They revised 28, and they deleted 287 codes. 150 of the new codes were added to the CC and MCC lists, and 17 were removed from those lists. Coders will see significant changes in new codes and guidance for reporting dementia, head injuries, and long-term drug therapy. If I break that down a little bit further, in chapter five for mental and behavioral health, there are 83 new codes. 69 of them are for dementia to report with and without psychological symptoms. There are also new guidelines for reporting dementia that emphasize that providers must clearly document the severity of the patient’s condition. If the documentation is incomplete, the coder should default to the unspecified code. In addition, the updated guidelines stipulate that if a patient with dementia is admitted to an inpatient facility and gets worse throughout their stay, the coder should assign the highest severity level reported during that stay. Other notable changes include new codes in chapter nine for heart disease. We have the I25 category that’s been expanded to include the angina pectoris versus refractory angina pectoris.

There are also new codes for pericardial effusion, ventricular tachy, and there’s a considerable expansion of codes under the aortic aneurysm category. Endometriosis has also been expanded. We have new guidelines in chapter 15 for pregnancy, childbirth, and the puerperium for calculating weeks of gestation. Chapter 19 has a few categories with code expansions. So, in this chapter, you’ll see 86 new codes that relate to head injuries. There are new codes for injuries due to motor vehicle collisions, and new poisoning codes by methamphetamines. Like I had mentioned earlier, the Z category for long-term current drug therapy has been expanded. There are 15 new codes there. And we also have new codes for personal history and new patient and caregiver noncompliance codes.

Kelly: Wow, that’s a lot of great information. Thank you. It’s my understanding there are changes to procedure coding as well. Can you summarize those for us?

Kristen: Yeah. So, this group is not as large as the diagnoses codes. However, we do have 331 new procedure codes, 64 deleted codes, and no revisions. Changes to the guidelines include an addition of B3.19 for detachment, and then there’s two revisions to B4.1C for a tubular body part, and B61A for general coding of a device. A few of the table changes include– in the central nervous system and heart and great vessels section, we have new qualifiers. In the lower arteries, the root operation for occlusion has been updated, and it reflects right and left prostatic arteries. And then the largest and most significant change is that the laser interstitial thermal therapy, which is a mouthful, has been relocated from the radiation therapy section. So, this means the respiratory, the gastrointestinal, hepatobiliary, endocrine, skin and breast, and the male reproductive systems, all of those under the med surg category now have a major addition. The root operation destruction using that laser interstitial thermal therapy is now represented by qualifier three, and it is out of the radiation therapy section.

Kelly: Wow, again, that’s a lot of great information there too. Did CMS implement any changes to the MS-DRG system?

Kristen: No. So unlike the two questions before where I had a lot to say, CMS did not propose any new MS-DRGs for fiscal year 2023. The number remains at 767 DRGs. However, they did modify how they calculated the relative weights of those DRGs. And while there aren’t any new MS-DRGs, there are three situations where CMS has reassigned the DRG, and those situations are for ARDS, cardiac mapping, and a lap cholecystectomy with a common bile duct exploration.

Kelly: Great. And do you have any tips for preparing for these new coding changes?

Kristen: First, I would strongly encourage and invite everyone to attend our upcoming webinar next Wednesday, September 28th. I think it’s at 1:00 PM. Here, I’ll have a more detailed review of all the coding and guideline changes that you could expect for 2023. Additionally, there are so many resources available online. All coders and CDI professionals should become familiar with the fiscal year 2023 CM and PCS official coding guidelines. I recommend reading the 2023 addendum. It reveals what changes occurred in the tabular list by each chapter, so it’s an easy way to find new, deleted, or revised ICD-10-CM codes. I would also strongly encourage you to visit the IPPS Final Rule homepage, which you can get to from cms.gov. There, you’re going to find many tables to download, including like table 5, which is your list of MS-DRGs. Table 6I and 6J are very useful, as well, and they include the ICD-10-CM diagnoses codes that are classified as your MCC or CC for the fiscal year 2023.

Kelly: Those are some great tips. Thanks so much, Kristen, and we really appreciate you joining us today.

Kristen: Well, I appreciate everyone here. Thank you for listening. I really enjoyed sharing this information with you, and I hope to see you all next week on our webinar.

Kelly: Thank you so much for joining us today, Cody.

Kristen: Yeah, Kelly, of course. Thanks for having me.

Kelly: Yes. And as Kristen mentioned, she will be presenting a webinar next Wednesday, that’s September 28th at 1:00 PM Eastern time. You can find more information on our website at besler.com. And thank you, again, for sharing this great information regarding coding updates from IPPS 2023. We appreciate you all joining us for this episode of The Hospital Finance Podcast. Until next time.

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER, SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

 

If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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