ICD-10-CM and PCS FY 2020 updates looming – are you prepared?

ICD-10-CM and PCS FY 2020 updates

The 2020 IPPS Proposed Rule indicates many changes to ICD-10 for FY 2020 including some significant ones to MS-DRG payments-some higher and some lower. A link to the CMS website to familiarize you with the changes is provided at the end of this article. Please note that by the time you read this article some or all of these “proposed” updates and changes for 2020 may be finalized.


Here is a partial list breaking down some of the new and updated information, proposed and final, that HIM and CDI staff will need to be aware of starting October 1, 2019 when the updates for FY 2020 take effect.
Final: New Diagnosis codes: 273
Final: New Procedure codes: 734
Final: Deleted/Invalid Procedure codes: 2,056
Proposed: Diagnosis Additions to major complications or comorbidity (MCC) list: 13
Proposed: Diagnosis Deletions to MCC list: 153
Proposed: Diagnosis Additions to complications or comorbidity (CC) list: 394
Proposed: Diagnosis Deletions to CC list: 1159
Proposed: Diagnosis codes with severity level changes (new CC or MCC or change from CC to MCC or MCC to CC): 1493

The numbers above are just a small taste of the 2020 IPPS changes which will take effect on October 1, 2019 and will take some time for CDI and HIM staff to master.

Some more interesting proposed changes are to the diagnosis codes describing pressure ulcers. There are 102 Pressure Ulcer diagnoses that currently are NOT a CC but are proposed to become a CC for 2020-this is a significant change. Conversely, and just as important, there are 50 Pressure Ulcer diagnoses that are proposed to be downgraded from an MCC to only a CC in 2020.

Another very important group of proposed changes involves the severity of obstetrical complications. There are 13 complication codes in this section of CM that are upgraded from a CC to an MCC; 124 codes that are not presently a CC or MCC that are upgraded to either a CC or an MCC (17 to an MCC and 107 to a CC); and 9 codes being downgraded from an MCC to a CC. Good news mostly but also extremely important to CDI, HIM professionals and providers to be sure that the documentation is accurate to capture only those diagnoses that are actually a complication-sometimes a very challenging process.

These figures are taken from the CMS website which is updated frequently as more of the “proposed” rules are finalized. Preparation to educate your staff on these changes is imperative. We are dedicated to providing our CDI and HIM consultants with the tools needed to perform at the top of their field including robust educational content via our Learning Management System (LMS) for updates, new clinical information and Continuing Education Credits.

For the most updated information on the FY 2020 changes to ICD-10 CM and PCS go to the following websites:
https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.html
https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html

 

Virginia Bailey RN, CCDS, CRC
Mid Revenue Cycle Content Manager, CDI