In a recent issue of ICD10 Monitor, I analyzed the proposed 2017 IPPS rule changes and identified key areas where coders need to pay close attention. This blog provides a quick overview of the coding areas most impacted by the proposed rule changes. For the full article with more details for each topic, click here.

Cardiovascular Monitoring Devices and Pacemakers

Practices and organizations specializing in cardiovascular treatments should be alerted to a number of changes in the coding directives. Noteworthy areas are changes to the coding of monitoring device insertion and revision. Specifically, some changes proposed relate to operating room versus non-operating room procedures. Not being aware of how to properly code these changes could impact revenue stream.

There are also a number of new ICD-10-PCS code combinations to describe pacemaker procedures. CMS hopes to simplify the coding of pacemaker devices and leads with the proposed changes.

Rehabilitation Codes

In the proposed changes, rehabilitation cases lacking a principal diagnosis code from the MDC 23 list but including a procedure code from the list of rehabilitation procedures for MS-DRGs 945 and 946, will not be assigned to MS-DRGs 945 or 946. The case will instead be assigned to a MS-DRG within the MDC where the principal diagnosis code is found. Closer scrutiny of rehabilitation coding is expected as more organizations participate in bundled payments and must closely monitor rehabilitation patients post-discharge.

Move from Surgical to Non-Surgical Procedures

Many procedures are moving from surgical to non-surgical procedures. Some categories impacted by this change include insertion of an infusion device, dilation of stomach, removal of drainage device, inspection of certain body sites, and endoscopic removal of infusion or monitoring device.

Confusing Information Regarding Pressure Injury

Coders should also be aware of a confusing shift in terminology. Pressure ulcers will be coded as pressure injuries under the proposed changes.  Currently, when the coder sees a diagnosis of a pressure ulcer, he or she goes to the index to find “ulcer,” and it takes them to the correct coding section.

Once coders start seeing the terminology for a pressure “injury,” they will logically look up “injury,” leading them to a traumatic injury code. This code is incorrect for these ulcers, and it is further complicated by the possibility that coders could start adding external cause codes (also incorrectly). Look for more guidance in the months ahead for these terms.

While there are other important changes in the proposed rule, these changes carry the highest potential impact for clinical coders. Stay tuned to our “On TEN” blog for the latest news and information on ICD-10 coding.