Effective October 1, 2024, the Inpatient Prospective Payment System (IPPS) Final Rule for fiscal year 2025 will be implemented. There are several coding areas impacted which includes the revision, addition, deletion of MS-DRGs, ICD-10-PCS procedure codes, title changes, and diagnosis codes, just to name a few.
Medicare-Severity Diagnosis Related Groups (MS-DRG)
The Centers of Medicare and Medicaid Services (CMS) has finalized the deletion of five Medicare Severity Diagnosis Related Groups (MS-DRGs) and twelve new MS-DRGs.
The 12 New Finalized MS-DRGs:
- MS-DRG 317 = Concomitant Left Atrial Appendage Closure and Cardiac Ablation
- MS-DRG 402 = Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical
- MS-DRG 426 = Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC OR Custom-Made Anatomically Designed Interbody Fusion Device
- MS-DRG 427 = Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC
- MS-DRG 428 = Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC
- MS-DRG 429 = Combined Anterior and Posterior Cervical Spinal Fusion with MCC
- MS-DRG 430 = Combined Anterior and Posterior Cervical Spinal Fusion without MCC
- MS-DRG 447 = Multiple Level Spinal Fusion Except Cervical with MCC OR Custom-Made Anatomically Designed Interbody Fusion Device
- MS-DRG 448 = Multiple Level Spinal Fusion Except Cervical without MCC
- MS-DRG 450 = Single Level Spinal Fusion Except Cervical with MCC or Custom-Made Anatomically Designed Interbody Fusion Device (former MS-DRG 459 which is now deleted)
- MS-DRG 451 = Single Level Spinal Fusion Except Cervical without MCC (former MS-DRG 460 which is now deleted)
- MS-DRG 850 = Acute Leukemia with Other Procedures
The 5 Finalized MS-DRG Deletions:
- MS-DRG 453 = Combined Anterior and Posterior Spinal Fusion with MCC
- MS-DRG 454 = Combined Anterior and Posterior Spinal Fusion with CC
- MS-DRG 455 = Combined Anterior and Posterior Spinal Fusion without CC/MCC
- MS-DRG 459 = Single Level Spinal Fusion Except Cervical with MCC (now finalized as new MS-DRG 450)
- MS-DRG 460 = Single Level Spinal Fusion Except Cervical without MCC (now finalized as new MS-DRG 451)
Title Revision
CMS finalized the title revision of MS-DRGs 834, 835, 836 and 836 from Acute leukemia without major O.R. procedures with MCC, with CC and without CC/MCC to Acute Leukemia with MCC, with CC, and without CC/MCC.
ICD-10-CM Diagnosis Codes
CMS has finalized the reassignment of following ICD-10-CM diagnosis codes which impacts MS-DRG 606 Diseases and disorders of the skin, subcutaneous tissue and breast and MS-DRG 795 Normal Newborn to MS-DRG 595 Major skin disorders with MCC and MS-DRG 596 Major skin disorders without MCC.
- 0 = Epidermolysis bullosa simplex
- 1 = Epidermolysis bullosa letalis
- 2 = Epidermolysis bullosa dystrophica
- 8 = Other epidermolysis bullosa
- 9 = Epidermolysis bullosa, unspecified
ICD-10-PCS Procedure Codes
CMS also finalized the addition of eight ICD-10-PCS codes to the logic of MS-DRG 018 Chimeric Antigen Receptor (CAR) T-cell and Other Immunotherapies.
The 8 New ICD-10-PCS Codes:
- XHR0XGA = Replacement of Head and Neck Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR1XGA = Replacement of Chest Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR2XGA = Replacement of Abdomen Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR3XGA = Replacement of B ack Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR4XGA = Replacement of Right Upper Extremity Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR5XGA = Replacement of Left Upper Extremity Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR6XGA = Replacement of Right Lower Extremity Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
- XHR7XGA = Replacement of Left Lower Extremity Skin with Prademagene Zamikeracel, Genetically Engineered Autologous Cell Therapy, External Approach, New Technology Group 10
There are changes in the number of ICD-10-PCS procedure codes that describe MS-DRG 317 Concomitant Left Atrial Appendage Closure and Cardiac Ablation which now have 25 procedure codes instead of 27.
The ICD-10-PCS Codes Removed:
- 02590ZZ = Destruction of chordae tendineae, open approach
- 02593ZZ = Destruction of chordae tendineae, percutaneous approach
- 02594ZZ = Destruction of chordae tendineae, percutaneous endoscopic approach
The only added ICD-10-PCS procedure code is 02583ZF Destruction of conduction mechanism using irreversible electroporation, percutaneous approach.
CMS has also finalized the addition of the following procedures impacting MS-DRGs 628, 629 and 630 Other Endocrine, Nutritional and Metabolic O.R. Procedures with MCC, with CC, and without CC/MCC.
- 0DTF0ZZ = Resection of right large intestine, open approach
- 0DTF4ZZ = Resection of right large intestine, percutaneous endoscopic approach
These are some of the IPPS Final Rule updates impacting code assignment. All coding professionals are encouraged to read the FY 2025 IPPS Final Rule in its entirety.
Find out more about the Coding Updates from IPPS 2025 in our On-Demand Webinar. Learn more and/or register now to join us.
