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CMS Releases 2014 IPPS Proposed Rule

Michelle A. Leppert, CPC, April 30, 2013

Readmissions reduction

CMS currently assesses hospitals' readmission penalties using three readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, and pneumonia. For FY2014, CMS plans to modify the readmissions rate to take into account planned readmissions within 30 days.

In addition, CMS proposes adding exacerbation of chronic obstructive pulmonary disease (COPD) and patients admitted for elective total hip or total knee arthroplasty (THA/TKA) to the readmissions reduction calculations for FY 2015.

CC/MCC changes

CMS proposes to add diagnosis code 575.0 (acute cholecystitis) to the CC Exclusion List when reported as a secondary diagnosis code with a principal diagnosis code 574.00 (calculus of gallbladder with acute cholecystitis without mention of obstruction).

CMS also proposes removing the following diagnosis codes from the CC Exclusion List for diagnosis code 440.4 (chronic total occlusion of artery of the extremities):

  • Atherosclerosis codes 440.20-440.32, 443.22, and 443.29
  • Aneurysm codes 441.00-441.03, 441.1-441.7, 441.9, 442.0, 442.2, 442.3, 442.9

The proposed rule does not include any revisions to the CC/MCC Exclusion List based on ICD-9-CM code changes.

MS-DRG changes

CMS is proposing to move stroke cases with ICD-9-CM code V45.88 (status post administration of tPA [rtPA] in a different facility within the last 24 hours prior to admission to current facility) as a secondary diagnosis from MS-DRG 066 to MS-DRG 065. CMS would change the title of MS-DRG 065 to Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 hours. Hospitals who receive patients undergoing a stroke-in-evolution who had tPA given at an outside facility demonstrated higher costs and lengths of stay in all stroke MS-DRGs without tPA (MS-DRG 64-66), particularly if there was a MCC.

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