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CMS Releases 2013 IPPS Final Rule

Michelle A. Leppert, for HealthLeaders Media, August 3, 2012

"Perhaps the Cooperating Parties will now revisit this advice and provide official follow-up that allows coders to use 584.8 when a physician links acute renal failure to a specified pathological lesion, such as lupus nephritis, acute glomerulonephritis, interstitial nephritis, or another renal pathology not covered in [codes] 584.5, 584.6, or 584.7, since 584.8 is no longer a MCC," Kennedy says.

Kennedy is pleased that CMS included mild and moderate malnutrition as CCs. He would like to see ICD-10 embrace the recently published American Dietetic Association / American Society for Parenteral and Enteral Nutrition consensus statement on malnutrition that classifies this entity as "non-severe" and "severe" instead of "mild," "moderate," and "severe." Click here to view this reference.

CMS did not add any MCCs or delete any CCs.

CMS finalized a proposal to reassign cases with a principal diagnosis code 487.0 (influenza with pneumonia) and an additional secondary diagnosis code of certain pneumonia codes listed as a secondary diagnosis codes from MS-DRGs 193, 194, and 195 to MS-DRGs 177, 178, and 179.

IQR program changes

CMS introduced the IQR program in 2004 with 10 quality measures, which have since increased to 72 measures. For FY 2015, CMS will reduce the number of quality measures to 59 and will add one measure for FY 2016.

CMS is also reducing the number of random samples from 800 hospitals to 400 hospitals because more than 99% of hospitals sampled reported accurate data. CMS reiterated that it will reduce payments for facilities that do not submit quality indicator data in timely manner, says Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta.

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