The IPPS FY 20 was released on April 24, 2019. Below are the highlights of the proposed changes.
CC/MCC Summary – Over 1000 codes that are currently CCs will become non-CCs in the proposed rule
| Proposed Shifts | # |
| Non-CC to CC | 183 |
| CC to non-CC | 1,148 |
| CC to MCC | 8 |
| MCC to non-CC | 17 |
| MCC to CC | 136 |
| Total | 1,492 |
Proposed CC/MCC changes (not complete listing)
| ICD-10-CM | Description |
Proposed Change |
| D61.810 |
Antineoplastic chemotherapy induced pancytopenia |
MCC to CC |
| D62 | Acute posthemorrhagic anemia | CC to non-CC |
| D70.9 | Neutropenia, unspecified | Non-CC to CC |
| E43 |
Unspecified severe protein-calorie malnutrition |
MCC to CC |
| G93.5 | Compression of brain | MCC to CC |
| I21.01-I21.11 | ST elevation MI | MCC to CC |
| K70.11 | Alcoholic hepatitis with ascites | Will remain non-CC |
| K70.31 | Alcoholic cirrhosis with ascites | Will remain non-CC |
| K71.51 |
Toxic liver disease with chronic active hepatitis with ascites |
Will remain non-CC |
| L89.- |
Pressure ulcers (unstageable, unspecified, stage 1-2) |
Non-CC to CC |
| L89.- | Pressure ulcers (stage 3-4) | MCC to CC |
| N18.4-N18.5 |
Chronic kidney disease, stage 4-5 |
CC to non-CC |
| N18.6 | ESRD | MCC to CC |
| R04.0 | Epistaxis | Non-CC to CC |
| R60.1 | Generalized edema | Non-CC to CC |
| R62.7 | Adult failure to thrive | Non-CC to CC |
| R78.81 | Bacteremia | CC to MCC |
| Z68.1 |
Body mass index (BMI) 19.9 or less, adult |
CC to non-CC |
| Z68.41-Z68.42 | Body mass index (BMI) 40.0-49.9 | CC to non-CC |
| Z94.0-Z94.83 |
Kidney, lung, heart, liver, bone marrow, intestine transplant status |
CC to non-CC |
MS-DRG Summary
- 15 proposed MS-DRG revisions
- 2 MS-DRGs removed
- 2 MS-DRGS added
Extensive OR Procedures Unrelated to PDX with MCC (DRGs 981-983)
- The conditions and procedures listed below currently group to DRGs 981-983; the proposed changes will shift these condition and procedure combinations out of DRGs 981-983
- Pressure ulcers with bone excision
- Lower extremity muscle and tendon excision
- Conditions in MDC 1 with insertion of feeding device
- Conditions in MDC 21 with peritoneal dialysis catheter insertion, removal, or revision
- Gastrointestinal Stromal Tumors (GIST) with excision of stomach and small intestine
OR procedures that will become non-OR procedures
- Percutaneous removal of drainage device
- Percutaneous drainage of pelvic cavity
- Bronchial alveolar lavage (BAL)
Peripheral ECMO
- 5A1522G – ECMO, peripheral veno-arterial and 5A1522H – ECMO, peripheral veno-venous will be reassigned to MS-DRG 003
- The following DRGs will no longer include, “or Peripheral ECMO” in their DRG description:
- DRG 207 – Resp. system DX with vent support > 96 hours or peripheral ECMO
- DRG 291 – CHF with MCC or Peripheral ECMO
- DRG 296 – Cardiac Arrest with MCC or Peripheral ECMO
- DRG 870 – Sepsis with mechanical vent >96 or peripheral ECMO
Extracorporeal shockwave lithotripsy (ESWL)
- Remove
- 691 Urinary Stones with ESW Lithotripsy with CC/MCC
- 692 Urinary Stones with ESW Lithotripsy without CC/MCC
- Add
- 693 Urinary Stones with MCC
- 694 Urinary Stones without MCC
Reference