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THE IMPLICATIONS OF ICD-10-CM/PCS for healthcare reimbursement is a topic at the top of everyone's mind in the healthcare industry these days. As healthcare organizations continue to prepare for the transition to ICD-10-CM/PCS on October 1, 2015, an essential and important element of a successful transition is the understanding of the implications that this transition will have on reimbursement for healthcare organizations.
United Audit Systems, Inc. (UASI), a vendor specializing in coding and revenue cycle solutions, has been performing ICD-10-CM/PCS documentation gap analysis projects for the past three years. In addition to assisting healthcare organizations with identifying and understanding specific gaps in their clinical documentation, these projects also included the performance of a financial simulation comparing the ICD-9-CM MS-DRG assignment to the ICD-10-CM/ PCS MS-DRG assignment. Overall, the financial simulation findings for various healthcare organizations have revealed only modest changes in the organization's case mix index (CMI), holding consistent with the Centers for Medicare and Medicaid Services' goal of a revenue neutral transition to ICD-10-CM/PCS.
This article will discuss some potential MS-DRG changes related to the organization and structure of ICD-10-CM/PCS, as well as the native MS-DRG grouper logic.
Analysis for Supraventricular Tachycardia
The code for supraventricular tachycardia in ICD-9-CM is 427.89, Other specified cardiac arrhythmias. The code 427.89 is listed neither as a major complication or comorbidity (MCC) nor as a complication or comorbidity (CC) when assigned as a secondary diagnosis in ICD-9-CM. In comparison, ICD-10CM has a specific code for supraventricular tachycardia, 147.1, which is listed as a CC.
This change has the potential of resulting in a higher MS-DRG being assigned in ICD-10 if supraventricular tachycardia is the only secondary diagnosis qualifying as either a MCC or CC. The following is an example scenario that illustrates the resulting MS-DRG change.
A patient is admitted to the hospital with a principal diagnosis of congestive heart failure and a secondary diagnosis of supraventricular tachycardia. In ICD-9-CM this case would be grouped to MS-DRG 293 (RW 0.6762). In...