IPPS Proposed Rule Detailed

Michelle A. Leppert, for HealthLeaders Media , April 26, 2012

CMS did not propose any major changes to the ICD-9-CM code set, which stands true to the original plan of doing a minimal update to ICD-9-CM for 2012, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding for HCPro, Inc, in Danvers, Mass. "Since we are proposing to use ICD-9-CM until October 1, 2014, it potentially adds another year of limited updates."

For FY 2013, CMS proposes to reassign cases with a principal diagnosis code 487.0 (influenza with pneumonia) and a one of a list of pneumonia codes listed as a secondary diagnosis codes from MS-DRGs 193, 194, and 195 to MS-DRGs 177, 178, and 179. CMS proposes to make three additional codes complications and comorbities (CCs) and change one major CC (MCC) to a CC for FY 2013. It does not plan to add any MCCs or delete any CCs.

CMS proposes adding these diagnoses to the CC list:

  • 263.0, Malnutrition of moderate degree
  • 263.1, Malnutrition of mild degree
  • 440.4, Chronic total occlusion of artery of the extremities

It also is proposing to change the severity level of diagnosis code 584.8 (acute kidney failure with other specified pathological lesion in kidney) from an MCC to a CC.

"While I support many of their CC/MCC changes, such as making mild and moderate malnutrition a CC, I am saddened that CMS still refuses to make heart failure not otherwise specified a CC," says James S. Kennedy, M.D., C.C.S., C.D.I.P., managing director at FTI Consulting in Brentwood, Tenn.

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