News: Functional quadriplegia MS-DRG changes

The fiscal year (FY) 2018 IPPS final rule includes updates to payment rates and quality initiatives, but some of the most extensive changes pertain to MS-DRG classifications and relative weights, according to JustCoding.

Most pertinent for CDI, CMS made changes to the classification of the diagnoses of functional quadriplegia and precerebral occlusion or transient ischemic attack with the use of a thrombolytic in Major Diagnostic Category (MDC) 1, Diseases and Disorders of the Nervous System, which covers MS-DRGs 020-103.

“There are always DRG reassignments every year, so this is expected,” said Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CRC, CCDS, director of HIM and coding at HCPro, an H3.Group division of Simplify Compliance LLC, located in Middleton, Massachusetts. “There may be a few more than normal as CMS is still encountering issues transitioning from ICD-9 to ICD-10, and those maps resulted in inaccurate reimbursement. This could be reflected in a relative weight change or seen as a perceived or real inaccurate DRG assignment.”

The use of updated comparative data from providers will help to create a more accurate DRG assignment for CMS, according to McCall.

“Now that CMS has a full set of ICD-10 data to use for DRG analysis, they will not be using comparisons to how something was coded in ICD-9 going forward,” McCall said. 

This week, we’ll review changes for functional quadriplegia.

CMS received requests from commenters to reassign cases identified by diagnosis code R53.2 (functional quadriplegia) from MS-DRGs 052 and 053 (spinal disorders and injuries with and without CC/MCC). The requestor stated that because functional quadriplegia does not involve any spinal injury or pathology, cases identified by the diagnosis code should not be assigned to MS-DRGs 052 and 053.

In the proposed rule, CMS reviewed the data for a total of 79 cases from MS-DRG 052 and MS-DRG 053 that reported a principal diagnosis of functional quadriplegia in MS-DRGs 052 and 053. The data analysis demonstrated that the average costs for these 79 cases are lower than the average costs of all cases in MS-DRGs 052 and 053, according to CMS. The data also showed that the average lengths of stay are shorter for cases reporting a diagnosis of functional quadriplegia in MS-DRG 052, but equal for cases in MS-DRG 053, CMS said.

Therefore, CMS said, its clinical advisors recommended assigning cases representing a diagnosis of functional quadriplegia to MS-DRGs 091, 092, and 093 (Other disorders of nervous system with MCC, with CC, and without CC/MCC).

During the proposed rule comment period, however, one commenter suggested that instead of assigning R53.2 to MS DRGs 091, 092, and 093 for FY 2018, CMS should instead reassign it to MS-DRGs 947 and 948 (Signs and symptoms with MCC and without MCC).

The commenter stated that R53.2 is located in Chapter 18, Symptoms, Signs and Abnormal Findings, because it can be the result of a variety of underlying conditions, making it inappropriate to classify as a nervous system disorder. The commenter also pointed out that other codes in category R53.- are assigned to MS-DRGs 947 and 948.

Through data analysis, CMS concluded that the average length of stay of functional quadriplegia cases are similar to those in MS-DRGs 947 and 948. Ultimately, CMS agreed with the commenter and finalized the assignment of code R53.2 to MS-DRGs 947 and 948.

As CMS continues to refine the ICD-10 MS-DRGs for FY 2019 it welcomes feedback on areas where MS-DRGs can be improved. Any comments should be sent to MSDRGClassificationChanges@cms.hhs.gov by November 1.

For more information on the rule, see CMS’ fact sheet. Changes become effective October 1 and the IPPS final rule is slated for publication in the Federal Register on August 14.

Editor’s note: This article was adapted from an article in JustCoding. To read more about the IPPS final rule, click here. Look for next week’s CDI Strategies for additional information regarding tPA changes. To register for a webinar focused on the changes within the final rule, click here.