Special Bulletin: CMS Releases IPPS Final Rule

There are no new MS-DRGs in the Final Rule.

The fiscal year (FY) 2023 Inpatient Prospective Payment System (IPPS) Final Rule, released by the Centers for Medicare & Medicaid Services (CMS), is short on coding news but remarkably long on its descriptions. The final rule weighs in at 2,087 pages.

“From the utilization review standpoint, it’s hard to think that CMS could have made the IPPS final rule any more boring,” said Ronald Hirsch, MD, in an email to RACmonitor. “While there are notable changes and important discussions to read, there is no immediate effect on processes that must be instituted.”

According to senior healthcare consultant Laurie Johnson, the IPPS Final Rule contains ten new technology add-on payment items (NTAP). Fifteen items were continued from FY22, and twenty-five items are discontinued from FY22.

“Remember that the NTAP items add reimbursement to the MS-DRG payment,” cautions Johnson.

The new rule provides guidance regarding changes to the Medicare Code Edits (MCEs), surgical hierarchy, and changes to the Medicare Severity Diagnosis Related Groups (MS-DRG), according to Johnson.

“The relative weight change across the MS-DRGs is -5.6737 with 394 relative weights decreased from FY22 version,” Johnson said during her appearance on Talk Ten Tuesdays, the long-running Internet radio program.

Continuing, Johnson said the remaining 371 MS-DRGs increased their relative weights. The largest relative weight increase was for MS-DRG 4 (Tracheostomy with Mechanical Ventilation >96 Hours or Principal Diagnosis Except Face, Mouth, and Neck Without Major OR Procedures). There are no new MS-DRGs.

The final version of the ICD-10-CM and ICD-10-PCS codes was released by the Center for Disease Control and Prevention and CMS earlier this summer for FY23. The new version will be effective on Oct. 1, 2022.