News: FY 2021 IPPS Final Rule released, ACDIS Regulatory Committee suggestions adopted

Last week, CMS finally released the long anticipated fiscal year (FY) 2021 Inpatient Prospective Payment System (IPPS) final rule. There was a delay to the final ruling release because of the COVID-19 pandemic (typically, the rule publishes in early August). Even with the delay, however, the FY 2021 IPPS final rule will still go into effect on October 1. This gives healthcare organizations less than a month to prepare for updates.

There are 14 new guidelines for ICD-10-CM and eight revisions included in the final rule. Of the new guidelines, 13 provide coding and reporting direction for COVID-19, with the final new guideline relating to e-cigarette and vaping-related disorders.

As for ICD-10-CM coding changes, many of the suggestions made in the proposed rule were finalized, including (but not limited to):

• New additional D57 codes for more specified sickle-cell anemia
• New D89 codes for cytokine release syndrome
• A slew of new codes related to drug use and abuse (including alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, other psychoactive)
• New codes for both adult and juvenile rheumatoid arthritis and osteoarthritis
• New additional S20 codes for injuries to the thorax
• Expanded T40 codes for poisoning, underdosing, and adverse effects of fentanyl, tramadol, and other synthetic narcotics
• Deletion of code A84.8 for other tick-borne encephalitis (because of the specified additions)

• Deletion of code D59.01 for other autoimmune hemolytic anemias
• Deletion of some T40 codes for poisoning due to the specified additions
• Revisions to Z68 codes relating to both adult and pediatric body mass index
• Revisions to allergy status Z88 codes

Along with additions, deletions, and revisions to ICD-10-CM codes, the FY 2021 IPPS final rule includes changes to CC/MCC designations, including adopting a change advocated for by the ACDIS CDI Regulatory Committee.

Changes to the MCC list include:

• Addition of the final D57 codes for sickle cell anemia
• Addition of P91 codes for neonatal cerebral infarction
• Addition of U07.1 for COVID-19, which was already implemented on April 1, 2020

Changes to the CC list include:

• Addition of the D89.833-D89.835 codes for grades 3-5 cytokine release syndrome
• Addition of the F10-F15 and F19 codes related to drug use and abuse
• Addition of the T86 codes related to corneal transplants
• Addition of M80 codes for age-related and other osteoporosis with current pathological fracture
• Addition of N02-N07 codes conditions with C3 glomerulonephritis

The addition of the grades 3-5 cytokine release syndrome to the CC list is a direct response to the tireless work of individuals such as those on the CDI Regulatory Committee who submitted comments to CMS during the proposed rule comment period advocating for the change. To read more about their efforts and the letter they submitted to CMS on behalf of the ACDIS community, click here.

Editor’s note: The FY 2021 IPPS final rule can be found here. The entire list of changes to the ICD-10-CM/PCS codes are available in tables 6A-6K and 6P.1a-6P.4a of the rule. ACDIS coverage of the proposed rule can be found here.