July is coming to an end, so that means there are hopefully only a few days until we get the Inpatient Prospective Payment System (IPPS) Final Rule. That’s also just enough time to take a look at a couple of the proposed Diagnosis-Related Group (DRG) changes.
The first one is in MDC 05, Diseases and Disorders of the Circulatory System, and deals with cardiac pacemaker revisions and replacements. The proposal is to delete the five MS-DRGs related to these procedures: MS-DRGs 258, 259, 260, 261, and 262. DRGs 258 and 259 relate to cardiac pacemaker replacements with or without a major complication or comorbidity (MCC). DRGs 260-262 relate to cardiac pacemaker revisions with a three-way severity split. If something is deleted, there has to be a replacement for these cases. Two new proposed combined MS-DRGs will take their place with a two-way severity split, MS-DRGs 210 and 211.
MS-DRG 210 will be Cardiac Pacemaker Revision or Device Replacement with MCC, and MS-DRG 211 will be Cardiac Pacemaker Revision or Device Replacements without MCC. It has been 43 years since DRGs for pacemaker revision and replacement procedures were created. The proposed rule notes that this change was based on their analysis of claims data from the 2025 fiscal year (FY). It shows that the resource utilization now appears to be aligned, and the cases are now clinically coherent, making the restructuring of these DRGs appropriate. As part of this restructuring, PCS code XHH80HB, Insertion of Ultrasound Transmitter and Battery for Endocardiac Pacing Electrode in Chest, Subcutaneous Tissue and Fascia, Open Approach, New Technology Group 11, will assign to new DRGs 210 and 211 when reported as a standalone procedure.
We will stay in MDC 05 for our next DRG change. There is a proposal to delete MS-DRG 264, Other Circulatory System OR Procedures. Again, we know that if something is deleted, there has to be a replacement. Two new MS-DRGs are proposed here, MS-DRGs 361 and 362. MS-DRG 361 will be Other Circulatory System OR Procedures with MCC, and MS-DRG 362 will be Other Circulatory System OR Procedures without MCC. In this case, a review of claims data supported the restructuring of the MS-DRGs with a two-way severity split, noting either with or without MCC. All the 1,447 procedure codes currently in the GROUPER logic for MS-DRG 264, which is proposed to be deleted, will be reassigned to the GROUPER logic for new MS-DRGs 361 and 362.
Finally, we look at some changes regarding prostatectomy procedures. These changes will affect both MDC 11, Diseases and Disorders of the Kidney and Urinary Tract, and MDC 12, Diseases and Disorders of the Male Reproductive System. In MDC 11, eight PCS code combinations will be removed from the GROUPER logic for MS-DRGs 665-667. These are Prostatectomy with MCC, with CC and without CC/MCC. In MDC 12, the same eight PCS code combinations will be removed from the GROUPER logic for MS-DRGs 707 and 708, Major Male Pelvic Procedures with and without CC/MCC, respectively. PCS codes 0VT00ZZ, Resection of prostate, open approach and 0VT04ZZ, Resection of prostate, percutaneous endoscopic approach, are proposed to group to MS-DRGs 707 and 708. PCS codes for resection of prostate via a natural or artificial opening, 0VT07ZZ and 0VT08ZZ for endoscopic, would group to MS-DRGs 713 and 714.
This is just a sampling of the MS-DRG changes in the IPPS proposed rule. We don’t have long to wait to see which of the proposed changes will be included in the final rule.
Make sure you and your coding team are prepared for the upcoming changes.
