We are already halfway through September, so time has flown by since we first started thinking about the Inpatient Prospective Payment System (IPPS) Final Rule for the 2027 fiscal year (FY). Oct. 1 is truly right around the corner.
To help you prepare, today we will focus on some topics covered in the FY 27 IPPS Masterclass.
First up is vanishing twin syndrome and the new ICD-10-CM codes for this condition. Vanishing twin syndrome is the spontaneous loss and resorption of one or more fetuses in a multifetal pregnancy. In vanishing twin syndrome, at least one fetus continues to develop. While this is not new, it is being identified more due to the increased incidence of routine first-trimester ultrasound examinations being performed. Surviving fetuses do face some higher risks due to vanishing twin syndrome, such as preterm birth and growth restriction.
The new code sets for vanishing twin syndrome specify the trimester, with O31.40X0-O31.40X9 as the unspecified trimester option. O31.41X0-O31.41X9 identifies the first trimester, O31.42X0-O31.42X9 identifies the second trimester, and O31.43X0-O31.43X9 identifies the third trimester. Our seventh-character values identify the fetus affected. 0 is the value for not applicable or unspecified, 1-5 identify fetuses 1-5 and 9 identifies other fetus. For example, vanishing twin syndrome affecting the first fetus in the second trimester would be assigned O31.42X1, Continuing pregnancy after vanishing twin syndrome of one fetus or more, second trimester, fetus 1.
Looking at ICD-10-PCS, there are several new codes identifying vein bypass using autologous cell seeded tissue. Code X2K00FB, Bypass Inferior Vena Cava using Autologous Cell Seeded Tissue Engineered Resorbable Scaffold to Pulmonary Artery, Open Approach, New Technology Group 11. This is a tissue-engineered conduit for children with single-ventricle congenital heart disease.
The scaffold bypass connects the inferior vena cava to the pulmonary artery. It is biodegradable and uses autologous bone-marrow cells. One exciting note is that this will potentially grow with the child. This procedure is investigational and not commonly used, but certainly has the potential to be an amazing technology for such patients. The second new code is X2KG0FB, Bypass Hepatic Vein using Autologous Cell Seeded Tissue Engineered Resorbable Scaffold to Pulmonary Artery, Open Approach, New Technology Group 11. This identifies the same technology, acting as a conduit, bypassing the hepatic vein to the pulmonary artery. This would also be used in treating congenital heart disease.
The Final Rule doesn’t just identify new codes; it also identifies codes that have been deleted or have had revisions. The next code today, XW0V0P7, has been revised. Currently, this code description is Introduction of Antibiotic-eluting Bone Void Filler into Bones, Open Approach, New Technology Group 7.
As of October 1, XW0V0P7 will be revised: Introduction of Gentamicin-eluting Bone Void Filler into Bones, Open Approach, New Technology Group 7. The change here is the added specificity of Gentamicin, rather than simply an antibiotic. As part of the new code additions for Oct. 1, we have XW0V0BC, Introduction of Vancomycin-eluting Bone Void Filler into Bones, Open Approach, New Technology Group 12.
So, with the code addition and code revision, we are now able to specifically assign for both Gentamicin and Vancomycin, rather than just simply antibiotic.
With just days until Oct. 1, make sure you and your coding team are ready with all the new codes and revisions. Check out the FY 27 IPPSPALOOZA for all the vital ICD-10-CM, PCS and MS-DRG information you need to know!
FY 2027 IPPS Final Rule Home Page | CMS
