In this episode, we’re pleased to welcome back Kristen Eglintine, BESLER’s Coding Manager of Revenue Integrity Services, to give us a glimpse into BESLER’s upcoming webinar Coding Updates from IPPS 2024, on Wednesday, September 27th at 1 PM ET.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- ICD-10 CM changes
- CMS finalized changes to the severity level designation for three ICD-10 Z codes
- Additional changes to the MCC and CC lists
- Changes to procedure codes
- Changes to the MS-DRG system
- How coders can prepare
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Kristen Eglintine, BESLER’s Coding Manager of Revenue Integrity Services. In this episode, Kristen will give us a glimpse into BESLER’s upcoming webinar, Coding Updates from IPPS 2024, that we’re hosting on Wednesday, September 27th at 1 PM Eastern Time. In that webinar, we will discuss highlights of the fiscal year 2024 IPPS Final Rule, which CMS published on August 1, 2023, with all coding changes effective October 1, 2023. Welcome back and thank you for joining us today, Kristen.
Kristen Eglintine: Hi, Kelly. Hi, everyone. Thanks for having me again. I’m really excited to be here and talk about this new update.
Kelly: Yeah, so are we. So, let’s jump in. So, it’s that time of year again when we prepare for updates to the IPPS, which includes revisions to the ICD-10 code set. For the past few years, we’ve been in a public health emergency when the IPPS was finalized and published. The public health emergency officially ended on May 11, 2023. So does the 2024 Final Rule reflect that we may be back to “normal”?
Kristen: I hope so. It’s been a long few years for all of us in healthcare, so I’d really like to say yes. I think we’re headed back that way. There’s been a lot of attention given to COVID the past few years, but that changes for 2024. Effective September 30th of this year, 2023, CMS has ended the NTAP payments for COVID-19 treatments, and they did not renew them for fiscal year 2024. But what CMS has continued to do is add specificity and they’ve expanded some condition codes, updated some guidelines, so I’m really excited to share what changes we will be seeing come October 1st.
Kelly: Yes, me too. I’m sure everybody is. There are many components of the IPPS Final Rule. Financial changes were covered in another webinar BESLER presented earlier in September 2023. Can you touch on a couple of ICD-10 CM changes that coders can expect to see in October 2023?
Kristen: The ICD-10 CM update is relatively small compared to last year’s update. However, some of the changes are significant and, I think, exciting. So, for this coming year, we will have 74,044 total ICD-10 CM codes. 395 of them are new, 25 were deleted from last year, and we have 13 revised codes. In Chapter 9, coders are going to see some significant changes in cerebrovascular accident entries, arterial sclerosis with infarction entries. They’ve done some updating to correct code assignments for bronchitis due to fumes and vapors. And additionally, in some other chapters, cachexia has changed. The main index entry was changed from R64 to E43 for unspecified severe protein-calorie malnutrition. There are also new entries under cachexia due to malnutrition and due to underlying conditions. There’s a new code, E88.A, for wasting disease syndrome due to an underlying condition. So those are some significant changes around the malnutrition area. We’ll also see some changes around the elevated troponins. So, the index entry was changed from R77.8 to an R79.89 for other specified abnormal findings of blood chemistry. There’s a coding clinic and this aligns nicer with it, so I’m excited about that change.
We have a new code for resistant hypertension. There’s been some code expansion for Parkinson’s disease, so G20 was expanded to identify the disease with or without dyskinesia and with or without fluctuations. We have a new code in, again, Chapter 9 for coronary microvascular dysfunction. So, there’s some codes that include coronary microvascular dysfunction disease, and they were added to include a new code for a myocardial infarction without the occlusive disorder. Osteoporosis codes have been expanded to include many more sites. We have a lot of new external cause codes for foreign body entries into natural orifices. So, these codes have been added to differentiate specific foreign bodies, such as a battery or a button or an earbud or any other objects that enter through natural orifices. We have new Z codes for child custody status. We have new Z codes for caregiver non-compliance as well. There has been some exclude-one notes, which were changed to exclude-twos under the J43s for emphysema and J44 code categories for COPD. So, there’s a lot of changes in a lot of different chapters that I’m excited to see us roll out.
Kelly: Wow, seems like a lot of changes there. Thanks, Kristen. CMS finalized changes to the severity level designation for three ICD-10 Z codes for homelessness. Can you explain that a little bit more?
Kristen: Yeah, so this is a change we had talked about last year that we were hoping would be implemented, and we do have that for this coming year. So, for fiscal 2024, the Z codes for homelessness are now CCs. In the past, they were non-CCs, so this is going to affect reimbursement. So, this is a very significant and important change. So again, for fiscal year 2024, homelessness Z codes will now have a CC designation. CMS recognized homelessness as an indicator of increased revenue and resource utilization in the acute inpatient hospital setting. So, if homelessness is documented, reporting Z-codes for homelessness unspecified, sheltered homelessness, or unsheltered homelessness as secondary diagnoses can result in higher payments to hospitals. So again, something I’m really excited for.
Kelly: Yeah, that sounds great. In addition to homelessness, were there additional changes to the MCC and CC lists?
Kristen: We have 18 MCCs added for this year. However, the MCC and CC lists…they were only modified to accommodate the new codes. There were no existing codes that were bumped up per se. So, there wasn’t a code with a CC designation that was bumped to an MCC. The only new MCCs we got are the new codes. But there are a few that are worth mentioning. So, we have a new code for sepsis due to Acinetobactor Baumaii. It’s a gram-negative bacteria that causes an infection in immunocompromised patients. It’s become increasingly drug-resistant, so we have this new code to capture that specificity for sepsis, and that’s A-4154. We also have a J-1561 for pneumonia due to that same gram-negative bacteria. There are several new MCCs in the sickle cell code range, as well as acute appendicitis codes. And then we rarely have new updates to chapter 15 for pregnancy, childbirth, and the puparium. But for this year, we do have two new MCCs. We have 090.41 for hepatorenal syndrome following labor and delivery and 090.49 for other postpartum acute kidney failure.
Kelly: Thank you for that. So that’s a great summary of changes to diagnosis codes. Are there changes to procedure codes as well?
Kristen: Not as many, but yes. For fiscal 2024, there’s going to be 78,603 total ICD-10 PCS codes. We have 78 new codes. Five were deleted from last year. And we have 14 revised titles. So, some of the new things we will be seeing for this year– for example, the aortic short-term external heart assist system. So, for this system, we have new codes that were created for the insertion, removal, and revision of this system. We also had created a new device character R for short-term external heart assist system, and assistance with cardiac output using an Impella pump continuous must be coded with insertion if performed. Moving to a different procedure, so a magnetic lengthening device for esophagus. So here, we have three new body parts added. So, we have esophagus upper and middle and lower added to the insertion table, along with magnetic lengthening device for this procedure. So, moving on to the heart, we added an extravascular lead to be used for mediastinal for extravascular devices.
Intubated prone positioning. So, when this is performed, it was added to the respiratory assistance as a qualifier, typically done for COVID-19 patients, but was worth adding as a qualifier going forward. And then moving on to Section X. So, this is the section that’s reserved for new technology, and here, we have a lot of new exciting things coming up. So, we have some ablation of renal sympathetic nerves or insertion of an SVC or an IVC bioprosthetic valve, implanting bioprosthetic femoral venous valves, or implementation of a conduct to short-term external heart assist systems. And all of these, again, they are falling under a Section X, again, for new technology. These may be paid as new technology add-on payments or NTAPs. So coding X section codes is crucial as it does affect reimbursement.
Kelly: Thank you for that summary. Last year, CMS did not implement any changes to the MS-DRG system. What can we expect for fiscal year 2024?
Kristen: So, I think there are some exciting changes to our MSDRGs for 2024. Last year, like you said, there were only weight revisions. No new DRGs, just the weights were revised. But for this year, CMS created 15 new MS-DRGs. They deleted 16 with those additions. This is because some of the existing MS-DRGs, they were expanded to include CCs or with MCC and with or without a CC or an MCC. But the majority of our MSDRG changes for this year were in the MDC5 for diseases and disorders of the circulatory system. So, two examples. There were several reassignments of the MSDRGs for procedures that make more sense, one being around the neurological eye disorders. So, we are moving–when you have central or retinal branch artery occlusions, so those diagnosis codes from the MS-DRG 123, they’re being moved to the 124-125 under disorders of eye with an MCC or thrombolytic administration or with an MCC along with adding a procedure code to capture a thrombolytic agent for that new DRG. So, if you have, like I said, the occlusion and you were given the thrombolytic agent, we now have a DRG that can better represent that situation. Another example is for percutaneous cardiovascular procedures with stents. So, prior to 2024, we were using the MS-DRGs 246 to 249, and they were differentiated by the type of stent, whether a bare stent or a drug-eluting stent. Going forward, we’re using the DRGs 321 or 322 for percutaneous cardiovascular procedures with intraluminal devices with an MCC or four-plus arteries or without an MCC. So, they’re taking away the division based on the type of stent.
Kelly: Thank you for that overview of those changes to the MS-DRGs. Preparation is key to ensuring coders are ready for the fiscal year 2024 changes. Can you make any suggestions as to how they can prepare?
Kristen: This podcast is just an introduction to our upcoming webinar that would greatly help any coder, validator, CDIS prepare for the coding changes we will see October 1st. The webinar is scheduled for next Wednesday, September 27th, at 1 PM Eastern Standard Time, and I strongly encourage and invite everyone to attend for a more detailed review of coding and guideline changes you can expect to see. If you can’t attend the webinar, there are many resources available online to help with preparation for the changes, such as the fiscal year 2024 ICD-10 CM/PCS official coding guidelines. All coders, validators, CDIS should be familiar with them. Additionally, the 2024 addendum reveals what changes occurred in the tabular list by each chapter. So, it’s an easy way to find new, deleted, and revised ICD-10 CM codes. As in past years, I also suggest coders or validators or CDIS download Table 5 from CMS’s website. This is the finalized list of MSDRGs. Tables 6I and 6J are also very useful, as they include ICD-10 CM diagnosis codes classified as MCCs and CCs for the new fiscal year. I hope you found the upcoming changes as exciting as I do. Thank you for choosing to spend a few minutes of your day with us. I really enjoyed sharing this information with you, and I hope to see you all on our webinar.
Kelly: Wow, thanks, Kristen. That was a lot of great information, and we appreciate this sneak peek into the upcoming webinar, like you mentioned, Coding Updates from IPPS 2024 that you’re presenting live on September 27, 2023. And as a bonus, you can earn CPE. We really appreciate you being here, Kristen.
Kristen: Thanks, Kelly. Thanks, everyone. Have a great day.
Kelly: And thank you all for 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.
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