Summer is already flying by! It is hard to believe that we are at the end of June – where does the time go? To continue our look at the Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2027 fiscal year (FY), we will focus on major complication and comorbidity (MCC) and some (CC) conditions in this article.
At the end of the article, I have also included the link to the Centers for Medicare & Medicaid Services (CMS) Proposed Rule Home Page, and I encourage you and your coding team to review it. The proposed additions to the MCC list can be found in Table 6I.1. There are a total of three additions to the MCC list for FY 2027, and we will take a look at each of them.
First up is J4B, Pulmonary mycetoma. Currently, mycetoma is coded to B47.9, Mycetoma, unspecified. B47.9 is currently a CC condition. In the Alphabetic Index, there is no further entry to specify as pulmonary. This is a new code, allowing for specificity to be assigned. B47 falls into the Mycoses code range of B35-B49 in Chapter 1, Certain Infectious and Parasitic Diseases.
Our new J4B code will fall into the Chronic lower respiratory diseases code range of J40-J4A, which will now be expanded to J40-J4B.
According to a Mayo Clinic Radiology Abstract, a mycetoma (which they also refer to as a “fungus ball”) is “…typically caused by an Aspergillus superinfection of a pre-existing cavity or cyst.” It further notes that while mycetomas can be multiple, they are usually solitary, and can occur anywhere in the lung where a cyst or cavity has formed, often due to a chronic disease like tuberculosis. On an artificial intelligence (AI) note, Copilot notes that pulmonary mycetoma is also known as aspergilloma.
In the Alphabetic Index, aspergilloma instructs the coder to see aspergillosis. We currently have a code for pulmonary aspergillosis, B44.1, which is a CC condition. If J4B is finalized, we will watch for additional clarification in Coding Clinic, which generally arrives in the fourth-quarter edition.
Our next and final two MCC additions are K6A.01, Prevesical abscess, and K6A.09, Other pelvic abscess. According to Merriam-Webster, “prevesical” means situated in front of a bladder, and especially the urinary bladder. Currently, there is no Alphabetic Index entry for abscess, prevesical.
From the Alphabetic Index, abscess, bladder instructs the coder to see Cystitis, specified type NEC. We do however have an Alphabetic Index entry for perivesical at abscess, which also instructs the coder to see Cystitis, specified type not elsewhere clarified (NEC). For the pelvic abscess, currently, the Alphabetic Index entry requires the coder to identify female or male before being directed to a code option.
Again, we will have to watch and see if these codes are included in the final rule, and if they will be considered to be MCC categories.
For our proposed CC condition additions, we would look at Table 6J.1. There are 56 proposed additions to the CC list for FY 2027. Several weeks ago, on Talk Ten Tuesdays, I discussed two of them: new body mass index (BMI) value codes Z68.18 and Z68.19. Almost half of the proposed CC additions are new codes for other osteomyelitis. Currently, we can assign for shoulder, upper arm, forearm, hand, thigh, lower leg, ankle and foot, other site, multiple sites, and unspecified site. These are considered CC conditions currently. With the proposed new code additions, we will now be able to assign for laterality for those specified sites. This change adds consistency with the other types of osteomyelitis codes, wherein we already have the ability to assign for right, left, or unspecified.
We also will have specific codes for right, left, and unspecified shoulder, upper arm, forearm, hand, thigh, lower leg, and ankle and foot.
In addition to our other site code, we will also have two new proposed codes that allow for the assignment of other osteomyelitis of skull and face and sinuses. All these codes are proposed CC condition inclusions, and will be M86.8X11 through M86.8X89.
We only have a couple weeks to wait for the final rule to see which of the proposed new codes and changes will become final for Oct. 1, 2026.
Resources:
FY 2027 IPPS Proposed Rule Home Page | CMS
https://mayoclinic.elsevierpure.com/en/publications/mycetoma
