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CMS Proposes More Than 1K New Diagnosis Codes

Analysis  |  By Amanda Norris  
   April 19, 2022

CMS suggests 1,495 total changes to the ICD-10-CM diagnosis code set in the FY 2023 IPPS proposed rule.

Brain illness and injury, with a focus on dementia-related diagnoses, occupy a high volume of the 1,495 proposed changes to the ICD-10-CM diagnosis code set by CMS in the fiscal year (FY) 2023 inpatient prospective payment system (IPPS) proposed rule.

At the same time, CMS also introduced a minimal amount of new ICD-10-PCS procedure codes, including codes for reporting knee joint replacements.

Once finalized, these ICD-10-CM/PCS code changes will be used by the revenue cycle's coding team starting October 1.

CMS' proposed code changes also include a reissue the COVID-19 vaccine status-related ICD-10-CM codes and the COVID-19 vaccine administration ICD-10-PCS codes that were previously implemented on April 1.

In the proposed rule, CMS is also soliciting public comment on how the reporting of social determinants of health (SDOH) diagnosis codes may improve the ability to capture severity of illness, complexity of service, and/or utilization of hospital resources.

CMS says it is also interested in receiving feedback on how it might otherwise foster the documentation and reporting of the diagnosis codes describing SDOH to reflect each healthcare encounter and improve the reliability and validity of the coded data.

Applying data governance strategies can help healthcare organizations capture and use SDOH data, and a key part of that process has long been tied to appropriate coding.

"When it comes to revenue cycle, I think what it comes down to is quality," Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, AHIMA's director of health information thought leadership, previously told HealthLeaders regarding SDOH reporting. "We still want to focus on quality documentation, and quality documentation leads to better coding and just better data overall."

Lastly, CMS is not proposing any new Medicare Severity Diagnosis-Related Groups (MS-DRG) for FY 2023, which means the number of MS-DRGs would be maintained at 767 for FY 2023. But CMS says it has a number of proposals for technical refinements to MS-DRG assignments and it is requesting comment on issues relating to the classification of rare diseases or conditions that are represented by low volumes in claims data within the MS-DRG structure.

For more information on the proposed rule, see the Federal Register. Comments are due to CMS no later than June 17.

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.


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