Keeping up with MS-DRG Revisions

Rayellen Kishbach's picture

CMS has issued two errata and correction notices for how MS-DRG logic functions in FY2017. These changes may impact payment. This article highlights a few examples.

It is important to note that CMS published v34 r2 in time for implementation on 10/1/2016, but the v34 r3 was released after claims for FY2017 had begun, so improper payments may have occurred.

Percutaneous Cardiovascular Drug-Eluting & Non-Drug-Eluting Stent Procedures

In the v34 r3 correction (which was published after the start of FY2017), CMS indicated that the grouping logic for MS-DRGs 246-249 was not recognizing four or more stents, nor was it calculating the number of vessels and/or stents that equal four or more. This correction could impact payment of claims grouped under v34 r2. Please see ​34 Errata R3 (PDF) for a detailed code list, and the table below for a summary of the estimated national unadjusted payment rates for these four MS-DRGs. For a provider-specific rate, use the MediRegs MS-DRG Calculator, which is part of the Coding Suite subscription. 

Percutaneous Cardiovascular Procedure with STENT...

Drug-Eluting Stent Non-Drug-Eluting Stent MCC 4+ Vessels / Stents DRG Payment
Yes   Yes n/a 246 $19,209
Yes   No Yes 246 $19,209
Yes   No No 247 $12,536
No Yes Yes No 248 $17,981
No Yes No Yes 248 $17,981
No Yes No No 249 $11,433

Head Trauma Correction

The correction published in October, V34 Errata R2  (which was implemented before the start of FY2017), CMS indicated that three significant trauma codes were missing from the MS-DRG Grouping Logic. 

  • S02.101B Fracture of base of skull, right side, initial encounter for open fracture
  • S02.102B Fracture of base of skull, left side, initial encounter for open fracture
  • S02.109B Fracture of base of skull, unspecified side, initial encounter for open fracture

In the first version of the grouper, these codes, when used as principal and admitting diagnoses, were ungroupable. As of v34 r2, they now properly group to

  • MS-DRG 087 Traumatic stupor & coma, coma (Est. Natl Unadjusted Payment $4766).

Note that because these are trauma codes, their severity should NOT be considered for assignment to MDC 024. These three codes were incorrectly not excluded as CCs and were impacting grouping in MDC 24. 

Arterial Extirpation Corrections

In an other example from the V34 Errata R2, 15 ICD-10-PCS procedure codes were incorrectly assigned to MS-DRG 252-254 instead of to MS-DRG 270-272. The table below shows the difference in payment for these assignments.

Est. National Unadjusted Payment FY 2017

270 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC $28,106
271 OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC $18,469
272 OTHER MAJOR CARDIOVASCULAR PROCEDURES  W/O CC/MCC $13,655
252 OTHER VASCULAR PROCEDURES W MCC $19,564
253 OTHER VASCULAR PROCEDURES W CC $15,616
254 OTHER VASCULAR PROCEDURES W/O CC/MCC $10,491

Additional Changes

The examples above are a sampling of corrections. You can read the errata to the MS-DRG Definitions Manual here: 

When You Have To Be Right

The Coding Suite has been updated to reflect these changes and corrections.

The MediRegs MS-DRG Grouper & Calculator will allow you to perform claims scenario analysis and look at reimbursement updates such as those highlighted in this article. Thousands of professionals use this tool for audit and revenue integrity work every day. We also provide an upgrade to the MS-DRG Analyzer, which provides batch grouping capability and deeper payment analysis (ACA impact, Outlier payments, What-If analysis) and an opportunity to calculate and compare by geographic region. 

 

 

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