On August 2, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule. The rule contains many changes to MS-DRGs that will significantly affect the day-to-day work of physicians, CDI specialists, and inpatient coding professionals invested in MS-DRG documentation and coding integrity and compliance.

FY 2020 ICD-10-CM Updates

Although there are 273 new ICD-10-CM codes this year the changes are impactful and will help us capture greater code specificity. These new codes also include some new concepts, including:

  • Expansion of atrial fibrillation codes
  • Expansion of embolism and thrombosis codes
  • Expansion of orbital fractures
  • New codes for pressure-induced deep tissue injury

FY 2020 ICD-10-PCS Updates

For FY 2020, there will be a total of 77,559 ICD-10-PCS codes, which includes 734 new codes and 2,056 deleted codes. There will be fewer ICD-10-PCS codes in 2020 than this year. Why is that?

One reason is because in the peripheral artery body systems Upper Arteries and Lower Arteries of the Medical and Surgical section, qualifier value Bifurcation was deleted from all tables — 037 Dilation of Upper Arteries, 04C Extirpation of Upper Arteries, 047 Dilation of Lower Arteries, 04C Extirpations of Lower Arteries, and 04V Restriction of lower arteries. The original proposal for the qualifier Bifurcation was intended to capture data regarding procedures on the coronary arteries. The qualifier Bifurcation will remain as is in the Heart and Great Vessels body system PCS tables.

FY 2020 IPPS Updates

Annual IPPS changes affect more than just codes – there are changes affecting DRG methodology, DRG weight, new technology add-on payment (NTAP), as well as changes integral to the HAC/PSI initiative.

Highlights include:

  • The promotion of 18 codes in the Z16.x, Resistance to antimicrobial drugs code category to CC’s.
  • Approved NTAP and ICD-10-PCS codes for drugs to fight the increasingly antibiotic-resistant pathogens

Tips for Successful Implementation of Changes

  1. Don’t just learn the new codes. Understand the rationale behind the changes to be sure you can recognize documentation needs, apply the coding updates, and identify potential MCC and CC changes.
  2. Use all the resources available to you. It’s always a good practice, for example, to use both the codebook Index and Tabular.
  3. Be sure not only your coders but your clinical staff and CDI team are educated on the new codes and guidelines so your HIM team can all navigate new codes and concepts.

Taking the time to understand the changes will allow your organization to ensure the ongoing accuracy and compliance of your coding.