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CMS Releases 2014 IPPS Proposed Rule

Michelle A. Leppert, CPC, April 30, 2013

"I am grateful that CMS proposes to allow hospitals accepting patients with stroke-in-evolution who receive tPA at an outside facility to have code V45.88, in essence to count as a CC if a CC is not otherwise documented," Kennedy says.

CMS proposes reassigning the following diagnosis codes from MS-DRG 794 to MS-DRG 795:

  • V64.00, vaccination not carried out, unspecified reason
  • V64.01, vaccination not carried out because of acute illness
  • V64.02,vaccination not carried out because of chronic illness or condition
  • V64.04, vaccination not carried out because of allergy to vaccine or component
  • V64.06, vaccination not carried out because of patient refusal

In addition, all of the diagnosis codes currently assigned to MS-DRG 794 would be added to the "only secondary diagnosis" list for MS-DRG 795.

Discharge status codes

CMS proposes to add new patient discharge status code 69 (discharged/transferred to a designated disaster alternative care site) for MS-DRGs 280 (acute myocardial infarction discharged alive with MCC), 281 (acute myocardial infarction discharged alive with CC), and 282 (acute myocardial infarction discharged alive without CC/MCC) to identify patients who are discharged or transferred to an alternative site that will provide basic patient care during a disaster response.

CMS also proposes added 15 new discharge status codes for MS-DRGs 280, 281, and 282 to identify patients who are discharged with a planned acute care hospital inpatient readmission.

"I find it interesting that CMS is proposing new discharge codes only for MS-DRGs 280-282 to identify scheduled readmissions," Kennedy said. "If implemented, this means that provider and case management documentation must be explicit as to assist the coder or HIM abstractor in assigning these discharge statuses. Why CMS does not offer this for other conditions or treatments, such as renal or liver transplantation, perplexes me."

Comment on the rule

CMS will accept comments on the proposed rule until June 25 and will respond to comments in the final rule to be published by August 1. The proposed rule will be published in the May 10 Federal Register. Comments may submit comments electronically, via first-class or express mail, or via hand delivery.

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