Thursday, May 16, 2013

MS-DRG shifts in ICD-10-PCS

In a perfect world, inpatient facilities would receive the same payments for diseases and procedures after the switch to ICD-10-PCS. We know that won’t happen, that facilities will see some shift in MS-DRG assignment and as a result, different reimbursement.
question marksWhy will certain conditions track to different MS-DRGs? In part, code assignment to MS-DRGs will change because the coding guidelines are changing. Specificity is increasing in many cases and decreasing in a few.
ICD-10-CM also changes the meaning of some of the diagnosis descriptions by including more combination codes and is also changing the CC/MCC designations for some codes.
Don’t forget about coding errors. Coders may be incorrectly assigning an ICD-9-CM code now, which could lead to incorrect MS-DRG assignment. In ICD-10-PCS, coders may also assign an incorrect code by choosing the wrong root operation. That could also lead to a change in the MS-DRG.
Hospitals should begin looking at their top MS-DRGs and determining whether the documentation is sufficient to code in ICD-10. Then code the case in ICD-10 and see which MS-DRG it ends up in. Is it the same MS-DRG, a higher paying MS-DRG, or a lower paying one?
Then try and determine why the MS-DRG changed. Maybe you have more specific information. You could be picking up a CC or MCC you aren’t currently reporting. Are you correctly sequencing the codes?
Once you figure out what will happen with your top MS-DRGs, you’ll have a better understanding of the financial impact of ICD-10 and also have a starting point for physician education.

Entry Information

Michelle A. LeppertAbout the Author: Michelle A. Leppert, CPC, is a senior managing editor specializing in outpatient coding for, which provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.
In addition, she writes and edits the HCPro Inc. publications, Briefings on APCs andAPCs Weekly Monitor. Email her at

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