Annual coding adjustments are par for the course when it comes to CMS’s annual reimbursement updates. On rare occasions these changes can make a big difference in how hospitals are paid. This year, one such change caught our attention.
Recently the American Hospital Association released clarifying ICD-10 coding guidance that should shift hemodynamic support devices like Abiomed’s Impella device from valve MS-DRGs 216-218 to the higher reimbursed MS-DRG 215.
The somewhat unexpected change originated when the added specificity of ICD-10 coding revealed potential miscoding of percutaneous heart assist devices to lower-paying valve MS-DRGs under ICD-9.
Under ICD-10, coding for these devices requires both an insertion code and device code, which will assign it to MS-DRG 215 for “other heart system implant.” Specifically, the guidance calls for a code from table 02H that describes insertion of the device, and a code from table 5A0 that describes assistance with an impeller pump.
The change will likely lead to a significant shift of high-risk PCI and cardiogenic shock procedures with a percutaneous heart assist device to MS-DRG 215, which yields a significantly higher payment than the valve MS-DRGs, as outlined below:
FY 2017 payment by MS-DRG
Notably, MS-DRG 215 is not subject to a transfer penalty, which means that hospitals that implant an Impella device in a patient and then transfer that patient to another facility will receive full reimbursement for the care they provided. In such a case, the receiving hospital would code for assistance with an impeller pump.
Together, these changes are a boon for hub-and-spoke STEMI networks that treat cardiogenic shock patients.
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