As this summer comes to an end, we look forward to the cooler weather of fall. Oct. 1 is right around the corner. Before you grab that first pumpkin spice latte, make sure you and your coding team are aware of the changes in the fiscal year (FY) 27 Inpatient Prospective Payment System (IPPS) Final Rule.
Here is a big picture overview to give you some ideas of what you need to know.
For the ICD-10-CM codes, we had 190 code additions and 30 code deletions. We also had three new major complication comorbidity (MCC) condition additions for pulmonary mycetoma, prevesical abscess and other pelvic abscess. If you do obstetric coding, you will want to review the new code sets for specific types of ectopic pregnancies.
There are also have new codes covering all trimesters for vanishing twin syndrome. There is a new code for gender identity disorder in remission as well as new personal history codes identifying various stages of gender transition.
Coders also need to be aware that we had an expansion of the low body mass index (BMI) value code, Z68.1. Two new codes now identify a BMI value of 18.4 or less or 18.5-19.9. These new codes will remain CC conditions.
For the ICD-10-PCS codes, there are 101 new code additions and 38 code deletions. There isa new code set for procedures for division of the aortic or mitral valves. There are also new spinal fusion codes that identify the use of custom-made anatomically and virtually designed interbody fusion devices. We also have new codes for procedures involving the use of an Impeller pump, new wound management modalities, as well as several new computer-aided technologies. There are new codes for urinary filtration using selective cytopheretic that will be non-OR procedures affecting the MS-DRG assignment.
Looking at the FY27 new technologies, it is important coders know which ones are discontinued, which previous ones are still considered new and which ones have had add-on payments approved for this fiscal year. Prior to the Oct. 1 implementation, which is only a few weeks away, coders should review these lists.
This is vital to educate themselves and their team on which codes to be assigning to ensure to capture that additional payment. Remember these new technology add-on payments (NTAPs) are in addition to the MS-DRG reimbursement. ZEVASKYN™, one of this year’s approved new technologies, has an add-on payment of more than two- million dollars!
Don’t forget about the MS-DRG changes of which all coders need to be aware. This year there are changes in MDC 05, 08, 10, 11, 12 and 13. Two new MS-DRGs were created for hip or knee procedures with periprosthetic joint infections. Other changes involve extensive or complex spinal fusions, cardiac pacemaker revision or replacements and prostatectomies.
Also important to note, the annual review of procedure codes in DRGs 981-983 and 987-989 did not identify any cases needing reassignment. These are those extensive and non-extensive OR procedures unrelated to the principal diagnosis DRG sets.
There was a severity level change for homelessness, inadequate housing and housing instability Z59 codes. As of Oct. 1, these will no longer be considered CC conditions. Discussion in the final rule noted a similarity to the analysis of chronic illness diagnoses, further noting that a change of CC designation should be based on the expected resource use associated with the treatment of an underlying medical condition or illness rather than a patient’s social circumstances.
This is just a sampling of what changes are found in the FY27 final rule. Coders only have a couple of weeks to review and prepare.
Make sure you and your coding team are informed and ready to go on Oct.1
For more information on IPPS final rule, join us for the 2027 IPPS Masterclass with Christine Geiger and Franklin Martin here.
