With October 1 now just days away, it’s a good time to take a quick look back at some of the fast- approaching FY27 inpatient prospective payment system (IPPS) changes.
The focus today will be heart related. For ICD-10-CM changes, remember there was an expansion of cardiomyopathy codes. For dilated cardiomyopathies, the unspecified code option will now be I42.00. The next new code, I42.01, Familial-genetic dilated cardiomyopathy, allows for tracking and studying genetic cases.
Code I42.09, Other dilated cardiomyopathy, can be used to assign for cases where there is documented specificity, but no specific code for that condition. This may be for a post chemotherapy, a viral or an autoimmune dilated cardiomyopathy.
You will want to make sure your providers are documenting the etiology as specifically as possible.
There is now a code I42.81 for arrhythmogenic cardiomyopathy. In this type, the patient’s normal myocardium is replaced by fibrofatty tissue. This is an inherited disorder, and it can affect either one or both ventricles. Finally, code I42.89 will be assigned for other cardiomyopathies not elsewhere classified.
This will be the code selection for many other uncommon cardiomyopathies. All the new cardiomyopathy codes will be CC conditions. As of later this week, current codes I42.0 for dilated cardiomyopathy and I42.8 for other cardiomyopathies will be invalid.
Switching gears to ICD-10-PCS, we have a new technology new code for transcatheter septal scoring. Code X28M3DC will be assigned for Division of ventricular septum using transcatheter septal scoring technique, percutaneous approach, new technology group 12. You may hear this referred to as a SESAME procedure, with SESAME standing for Septal Scoring Along the Midline Endocardium. It is a highly specialized cardiac procedure that scores the myocardium to enlarge the left ventricle outflow tract.
This may be performed as part of a transcatheter mitral valve replacement (TMVR) or in cases of obstructive hypertrophic cardiomyopathy. Remember our “fun fact” on those new technology group numbers. ICD-10-PCS went into effect 10/1/2015, so our new – New Technology group for FY27 would be group 12. 2027 is 12 years after 2015.
Finally, let’s look at one of our MS-DRG changes for FY27. This change involves DRGs for cardiac pacemaker revision and replacement procedures. For FY27, DRGs 258, 259, 260, 261 and 262 will be deleted. DRGs 258 and 259 are for cardiac pacemaker device replacements both with and without MCC. DRGs 260 through 262 are for cardiac pacemaker revisions except device replacement with MCC, with CC and without MCC or CC.
To replace these DRGs, two new DRGs were created: DRG 210 for cardiac pacemaker revision or device replacement with MCC and DRG 211 for those cardiac pacemaker revision or device replacements without MCC. This is a restructuring that better reflects the alignment of resource utilization and clinical coherence of these cases.
These were just a few examples of some of the changes that will be taking effect in just a few days. I have included the link to the final rule home page in my article. There is still time to prepare your team. Be sure to check out the FY27 IPPS Masterclass for all the information on new codes, revised codes, and MS-DRG changes plus all the clinical information you need to help you assign codes with confidence.
