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Tuesday 30 April 2019

North Carolina Hospital CEOs Tout Benefits Of Medicaid Expansion To Governor, Health Leaders


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Giving Impoverished Parents $4,000 A Year Could Have Profound Impact On Child’s Cognitive Development


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Watch: Electronic Medical Records Investigation In Spotlight On C-SPAN



KHN senior correspondent Fred Schulte talks on C-SPAN’s “Washington Journal” program about errors and other problems with computerized health records — and answers viewers’ questions.


You can read KHN’s story about electronic medical records here.


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Health Industry Multimedia

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Grupos denuncian atención médica y de salud mental deficiente a los detenidos por ICE


Es sábado por la mañana y las mujeres de la familia Contreras en Montclair, California, preparan pupusas, tamales y tacos. Tienen que trabajar para reemplazar los ingresos de José Contreras, preso desde junio pasado en Adelanto ICE Processing Center, un centro privado de detención de inmigrantes en el sur de California.


La hija de José, Giselle, conduce una vieja furgoneta repartiendo pedidos de comida. Primero un hospital, luego un lavadero de autos, después un banco.


El padre de Giselle cruzó ilegalmente desde Guatemala hace más de dos décadas. Trabajó en la construcción hasta que los agentes lo arrestaron y lo llevaron a Adelanto. Durante tres meses, José estuvo sin su medicamento para la diabetes, contó Giselle. Ahora, los guardias se lo dan a cualquier hora del día y de la noche. Además, Giselle contó que los agentes de ICE le quitaron los anteojos para que no pueda leer documentos legales ni escribir cartas.


“Mi tía trató de llevarle gafas, pero no permiten darles nada”, dijo Giselle mientras conducía la furgoneta. “Dicen que les dan todo lo que necesitan”. Pero, “no…. no tiene gafas”.


Giselle explicó que a su padre, de 60 años, le aterroriza que lo deporten, y que el estricto ambiente de Adelanto lo ha hundido en una profunda depresión.


“Ahora sus charlas son más cortas”, dijo. “No nos habla y no pregunta ‘¿Cómo te ha ido hoy? ¿Cómo has estado?’ Siempre mira al suelo; no hace contacto visual porque está muy deprimido”.


La hermana de José, María Contreras, visita a su hermano todos los sábados. Ella le ha pedido que vea a un psicólogo en Adelanto, pero él dijo que, aunque llenó una solicitud médica, no recibió ayuda. “No hay respuesta, nada”, agregó María.


Adelanto se encuentra en un desolado tramo de una carretera en el desierto, a una hora al norte de la ciudad de Riverside. Unos 2.000 hombres y mujeres están detenidos aquí. Algunos llegaron recientemente durante el aumento de cruces fronterizos. Otros vivieron en los Estados Unidos durante años, indocumentados. En la sala de visitas, adonde llegan los detenidos con pantalones holgados y blusas azules, naranjas o rojas, hay un letrero en la pared que dice: “No pierdas la esperanza”.


El Grupo GEO administra este centro, un contratista federal con sede en Boca Raton, Florida, que gestiona prisiones privadas, y que tiene un historial problemático. El año pasado,  inspectores federales de la Oficina del Inspector General del Departamento de Seguridad Nacional encontraron “sogas” hechas con sábanas en 15 de las 20 celdas. Según la inspección, los guardias pasaron por alto las sogas a pesar que un detenido se había suicidado con una sábana en 2017 y otros habían intentado suicidarse de manera similar. La auditoría concluyó que los guardias del Grupo GEO habían esposado y encadenado indebidamente a los detenidos, los habían puesto innecesariamente en régimen de aislamiento y no les habían prestado la atención médica adecuada.


Una foto familiar de José Contreras. Su hermana María está preocupada por su deterioro físico y mental desde que fue detenido. (Sarah Varney/KHN)(Sarah Varney/KHN)



Otra investigación de Adelanto y otros centros de detención de inmigrantes en California hecha pública, en febrero, por el Fiscal General del estado, Xavier Becerra, encontró problemas similares de salud y seguridad y concluyó que a los detenidos se los trataba como prisioneros que, en algún caso, permanecían en sus celdas durante 22 horas al día, aunque no hubieran sido acusados de delito alguno. Una ley estatal aprobada en 2017 obliga al estado a inspeccionar e informar sobre el trato a los inmigrantes detenidos en California.


Los casos documentados en el informe más reciente de Disability Rights California, un grupo con supervisión jurídica para proteger a personas con discapacidades en el Golden State, son brutales: detenidos que se cortan las venas; medicamentos para la depresión que se dejan de administrar; y peticiones de sillas de ruedas y andadores que no se atienden. Un detenido afirmó que los guardias le rociaron gas pimienta cuando no se paró, y luego cuando intentó ahorcarse.


En una declaración escrita, el Grupo GEO dijo que “rechaza las alegaciones” del informe, y que las medidas recomendadas por Disability Rights California “ya estaban en vigor”.


“Estamos comprometidos a ofrecer servicios de alta calidad, culturalmente apropiados, en entornos seguros y humanos”, dijo la compañía. Un portavoz de ICE dijo, en una declaración enviada por correo electrónico, que las instalaciones de Adelanto del Grupo GEO cumplen “con la Americans with Disabilities Act”.


Pero Mario, preso en Adelanto durante seis meses en 2018, dijo que el informe describe su propia experiencia.


“Lo que ocurre es que lo que se ha dicho contra GEO y su personal médico está ahora respaldado por informes”, señaló Mario quien pidió no revelar su apellido porque está en libertad bajo fianza y sigue luchando contra la deportación. Mario tiene 32 años y cruzó la frontera ilegalmente con sus padres cuando tenía 5.


En 2017 fue condenado por un delito menor y agentes de ICE lo arrestaron en su casa en Ontario, California. En ese momento Mario veía a un terapeuta para tratar su depresión y estaba medicado. Tardó tres semanas en volver a tomar antidepresivos, dijo, y las consultas con los psicólogos de Adelanto fueron superficiales.


“Las sesiones duran de cinco a diez minutos”, explicó. “Es como una facturación rápida. Sólo te preguntan: ‘¿Cómo estás? ¿Tienes pensamientos suicidas? ¿Cuándo es tu próxima cita en corte?’ Parece algo que se hace para decir: ‘Muy bien, está hecho'”.


Mario es gay y convivía con otros tres detenidos, uno de ellos era un homosexual mexicano que solicitaba asilo. Los dos se hicieron amigos íntimos.


“Fue perseguido en México por ser gay”, contó Mario. Meses de detención “y no recibir atención de salud mental le afectó mucho”. Y se cortó las venas. Se cortó la muñeca con una hoja de afeitar. Y lo castigaron con una semana de aislamiento”.


Mario, quien llegó al país con sus padres cuando tenía 5 años, estuvo detenido en Adelanto por seis meses en 2018. Asegura que todo lo que dicen los informes sobre la falta de cuidado en el centro de detención es cierto. (Sarah Varney/KHN)(Sarah Varney/KHN)



Mario dijo que cuando su amigo regresó, parecía medicado.


“Después de eso, dormía todo el tiempo”, contó Mario. “A la hora de comer, yo lo despertaba: ‘OK, es hora de comer'”, le decía.


Otros detenidos y abogados de inmigración describieron situaciones similares en las que psiquiatras de GEO recetan antipsicóticos que hacen que las personas duerman todo el tiempo. Según Mario, esa es una de las razones por las que se resisten a buscar ayuda. Además, al igual que a otros detenidos, le preocupaba que lo tildaran de depresivo.


“No podía expresar que me sentía triste, deprimido o ansioso porque temía que eso fuera usado en mi contra en la corte”, explicó.


Los jueces no pueden usar factores de salud mental para negar el estatus legal a un detenido, según abogados de inmigración.


Aunque el Grupo GEO anunció que los problemas apuntados en el informe de Disability Rights California hacía tiempo que se habían solucionado, en marzo los detenidos en Adelanto iniciaron una huelga de hambre. Le dieron a un abogado una nota escrita a mano que fue publicada por la Inland Coalition for Immigrant Justice, un grupo de defensa de los derechos de los inmigrantes.


La demanda principal era un acceso más rápido a una buena atención médica.


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California Mental Health Noticias En Español Public Health States

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A Big Hearing For ‘Medicare-For-All’ — In A Small Room


The first congressional hearing on a “Medicare-for-all” bill in at least a decade took place Tuesday, but without the usual phalanx of T-shirted supporters — or even the presidential candidates — who have been pushing the bill.


That’s because the hearing took place not at one of three major committees that oversee health policy in the House, but in the ornate — and comparatively miniature — hearing room of the House Rules Committee. That panel’s primary role is to set the terms for House floor debates, and its hearing room can seat about 50 people in the audience, compared with hundreds in the larger rooms of the Capitol complex’s office buildings. Also, members of the public cannot easily access the room on the third floor of the Capitol as they can the House office buildings across the street.


That arrangement was no accident — the Rules Committee is often called the “Speaker’s Committee” because it is so closely aligned with the speaker’s goals and is more heavily populated with members of the majority party than the usual committee breakdowns. House Speaker Nancy Pelosi has said repeatedly she does not want to push Medicare-for-all — a plan popular among progressive Democrats to move the country to government health care system — while Republicans control the Senate and the White House.


So, this hearing was the fulfillment of a promise she made to some of the more left-leaning members of her caucus when she courted them to support her candidacy for speaker. Another hearing, this one by the House Budget Committee — also not among the committees that would normally handle major health legislation, is expected to follow soon.


Those usual panels — Ways and Means, Energy and Commerce, and Education and Labor — are busy working on health legislation, including bills to address prescription drug prices and “surprise” medical bills, but not currently on a Medicare-for-all bill.


Rep. Michael Burgess (R-Texas) pointed out that anomaly. “I don’t want to say this hearing isn’t normal, but normally, health care policy would come … through the authorizing committees,” he said in a gibe to the House Democratic leadership. Burgess is also a member of one of those committees: Energy and Commerce.


Pelosi did make a cameo at the Rules hearing, escorting activist Ady Barkan, who has the neurodegenerative disease amyotrophic lateral sclerosis, or ALS, and was the star witness for the proponents of Medicare-for-all. Barkan, an outspoken critic of Republicans’ efforts to repeal and replace the Affordable Care Act in 2017, testified Tuesday by computer-generated voice, since his disease has progressed to the point he can no longer speak easily.


Still, despite the unusual venue, backers of universal health care hope the hearing marks the beginning of a journey to a new national health system.


“This is a historic moment,” Rules Chairman Jim McGovern (D-Mass.) said, surveying the standing-room-only crowd. “I don’t think we can squeeze anyone else in here.” McGovern said he is a strong supporter of the Medicare-for-all bill introduced by Reps. Pramila Jayapal (D-Calif.) and Debbie Dingell (D-Mich.), which has more than 100 co-sponsors.


For all the political machinations and sometimes overheated rhetoric about a major overhaul of the U.S. health system, the hearing itself was remarkably unremarkable — with witnesses both for and against the idea of the federal government providing health coverage to all Americans calmly discussing the pros and cons.


“The ugly truth is this: Health care is not treated as a human right in the United States of America,” Barkan told the committee. “This fact is outrageous. And it is far past time that we change it.”


Republicans were also eager to talk about Medicare-for-all — so they could bash it.


“This bill is an extraordinary bill,” said Rep. Tom Cole (R-Okla.), the panel’s ranking member. “It would completely change America’s health care system. And not for the better.”


And while the most enthusiastic backers of the bill were not in the hearing room, they were not far away.


More than 300 members of the California Nurses Association/National Nurses United, one of the unions that has been pushing Medicare-for-all for years, watched the hearing from an overflow room in the Cannon House Office Building and visited offices to try to gin up support, said co-President Malinda Markowitz.


Markowitz said she was optimistic about the path forward for the measure. “We’re going to continue to go to legislators that aren’t supporting this and let them know we’re not letting them off the hook,” she said.


Republicans want the debate to continue in Congress, too. They hope they can stoke fear of a government takeover of health care that will work to their advantage in the next election.


The top Republicans on the House Ways and Means Committee on Tuesday wrote to Chairman Richard Neal (D-Mass.) urging him to schedule a hearing on the bill. “A public accounting of H.R. 1384 is necessary to inform the working families and seniors we represent to the risks of their health coverage under this proposal,” said ranking Republican on the full committee, Rep. Kevin Brady (Texas), and the health subcommittee, Rep. Devin Nunes (Calif.).


That is apparently fine with Neal. In a brief interview Tuesday, he said his committee “likely would” hold a hearing in the current Congress. “I think we should have a full-throttle debate” about Medicare-for-all, he said.


Related Topics


Health Care Costs Insurance Postcards The Health Law

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CMS Proposes New Updates to Codes and MS-DRGs

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2020 IPPS proposed rule has a total of 149,405 ICD-10 codes.


The Inpatient Prospective Payment System (IPPS) Proposed Rule for fiscal year (FY) 2020 comes with a great many changes to the ICD-10-CM/PCS classification systems as well as the MS-DRGs.  While the IPPS applies to inpatient services for acute care hospitals, the proposed rule, released by the Centers for Medicare & Medicaid Services (CMS) on April 23 also contains an update for long term care hospitals (LTCH).  


The Centers for Disease Control and Prevention (CDC), along with CMS, have made significant changes to the diagnosis and procedure codes in this proposed rule. The CDC has proposed a net total of 252 new diagnosis codes while CMS has requested the elimination of a set of 1,660 procedure codes.
The code totals and changes are the following:

















Code TypeFY19 TotalsFY20 TotalsChanges
ICD-10-CM71,93272,184+252
ICD-10-PCS78,88177,221(1,660)
Totals150,813149,405


The new diagnosis codes can be found in Table 6A.  A summary of these codes is the following: 



  • Chapter 3 (Diseases of Blood and Blood Forming Organs) additions include D75. A (Glucose-6 phosphate dehydrogenase deficiency without anemia) and D81.3- (various codes for adenosine deficiency).

  • Chapter 8 (Diseases of the Ear and Mastoid Process), the new code is H81.4 (Vertigo of central origin).

  • Chapter 9 (Diseases of Circulatory System) include I26.93/I26.94 (Single/multiple segmental pulmonary embolisms), I48.- (expanded codes for atrial fibrillation), I80.24- (Phlebitis/thrombophlebitis of specified veins), and I80.4-/I80.5- (Acute embolism and thrombosis of specified veins).

  • Chapter 12 (Diseases of Skin and Subcutaneous Tissue), the new codes are in category L89. This category has been expanded with a sixth character of “6” which indicates pressure-induced deep tissue damage of various anatomic sites.    These codes have a severity status of Complication/Comorbidity (CC).

  • Chapter 14 (Diseases of the Genitourinary System) added codes to indicate an unspecified lump in the breast which overlaps quadrants (N63.15/N63.25).

  • Chapter 17 (Congenital Malformations, Deformations, and Chromosomal Abnormalities) has added codes in Q66 to indicate congenital deformities of the foot, expanded Ehlers-Danlos Syndrome (Q79.6-), and specified code for Prader-Willi Syndrome (Q87.11).

  • Chapter 18 (Signs, Symptoms, and Ill-Defined Conditions) has added R11.15 (Cyclical vomiting unrelated to vertigo) and expanded subcategory R82.8 to include pyuria and other abnormal findings on cytological or histological examination of urine.

  • Chapter 19 (Injury and Poisoning) has added numerous codes for orbital fractures (S02.12-, S02.83-, S02.84-, S02.85-). Poisoning codes have been added for poisoning by multiple medicaments (T50.91-) and heatstroke/sunstroke (T67.0-).

  • Chapter 20 (External Causes of Morbidity) has added various codes for a legal intervention involving firearms, explosives, gas, or other objects.

  • Chapter 21 (Factors Influencing Health Status and Contact with Health Services) has added codes for eye exam following failed vision screening (Z01.02-), testing for latent tuberculosis infection (Z11.7), latent tuberculosis (Z22.7), health counseling related to travel (Z71.84), personal history of in-situ neoplasm/melanoma (Z86.00-), personal history of latent tuberculosis (Z86.15), and presence of neurostimulator (Z96.82).

The new procedure codes can be found in Table 6B in the data tables associated with the proposed rule.   


Medical and Surgical Section: Codes were added for the bypass of central ventricle (0016-), bypass innominate (0312-), bypass of subclavian artery (0313-/0314-), bypass of axillary artery (0315-/0316), bypass of brachial artery (0317-/0318-), occlusion of gastric vein (06L2-), bypass of small intestine (0D18-), bypass of large intestine (0D1E-), extraction of breast (0HDT-), replacement of skin using autologous tissue substitute which is cell suspension (0HR–72), insertion/revision/removal subcutaneous defibrillator (0JH/0JP/0JW-FZ), and insertion of intramedullary limb lengthening internal fixation device (0PH—7Z).    


Administration Section: Codes were added for the transfusion of allogeneic related or unrelated T-cell depleted hematopoietic stem cells (30230U2/30230U3) and percutaneous endoscopic irrigation of joints, therapeutic or diagnostic (3E1U48X/3E1U48Z).  


Measuring and Monitoring Section: Codes were added for the monitoring of lymphatic flow using indocyanine green dye (4A16-5H).  


New Technology Section: Codes were added codes for the Introduction of new substances including Meropenum-vaborbactam (anti-infective), Apalutamide (antineonplastic), and Erdafitinib (antineoplastic). These codes have all been designated with the seventh character of 5 for Technology Group 5.  


In addition to making changes to the classifications, CMS has also requested changes to the severity designation of diagnosis codes. To state this update more clearly, some diagnosis codes will lose their major complication/comorbidity (MCC) status and some codes will gain that status. The same is true about complication/comorbidity (CC) status and some codes will gain CC status. Some diagnosis codes will no longer have MCC or CC designation. Here are two tables that display the update using only FY19 codes:


















SeverityV36V37 (Proposed)Change
MCC #3,2443,099(145)
CC #14,52813,691(837)
Non-MCC/CC54,16055,142+982

Another way to see the movement is in this table:
















Action# of Codes
Non-CC to CC183
CC to Non-CC1,148
CC to MCC8
MCC to Non-CC17
MCC to CC136
Total Changes1,492

The areas that are impacted predominantly with the severity shift are Neoplasms, Circulatory System, Skin and Subcutaneous Tissue, Genitourinary Systems, Injury and Poisoning, and Factors Influencing Healthcare Status. The neoplasm codes are moving CC to Non-CC status. The acute myocardial infarction codes are moving from MCC to CC status.  Pressure ulcers have many changes with some moving from MCC (stages 3 and 4) to CC and others are shifting from non-CC to CC. Examples of pressure ulcers that were non-CC and shifting to CC is L89.150 (Pressure ulcer, sacral region, unstageable). Acute pyelonephritis (N10) is shifting from non-CC to CC status and Severe persistent asthma with acute exacerbation (J) is shifting from CC to MCC status. Examples for Injury/Poisoning include S32.501A (Unspecified fracture of right pubis, initial encounter for closed fracture) is shifting from CC to non-CC and S72.011A (Unspecified intracapsular fracture of right femur, initial encounter for closed fracture) is moving from MCC to CC status.    Diagnosis code Z16.12 (ESBL Resistance) is shifting from non-CC to CC status and Z68.1 (BMI <19.9, adult) is shifting from CC to non-CC status.


A shift from OR to Non-OR designation has also been proposed for bronchoalveolar lavage (BAL), percutaneous drainage of the pelvic cavity, and percutaneous removal of drainage device. These procedure codes will no longer classify to a surgical MS-DRG. There are also proposed shifts from non-OR to OR designation. The percutaneous occlusion of the gastric artery (04L23DZ) will be added to the OR list for MS-DRGs 270-272, 356-358, 907-909, and 957-959.  


Follow the Money – Proposed MS-DRG Updates


There are approximately 13 MS-DRG changes that have been proposed. Please note that there were a few potential changes discussed in the proposed rule but were tabled for later investigation. Those proposals are not included in this summary.






















































TopicActionsOriginal MS-DRGNew MS-DRG
Peripheral ECMOReassign peripheral ECMO to MS-DRG 003 Retitle MS-DRGs 207, 291, 296, and 870207, 291, 296, 870003
Allogeneic Bone Marrow TransplantReassign some transfusion codes Delete 128 clinically invalid transfusion codes from PCS014016, 017
Carotid Artery StentsRemove 46 PCS codes (carotid artery w/o stent or other vessels) from MS-DRG 034, 035, 036 Remove 96 codes (dilation carotid artery w/stent) from MS-DRGs 037, 038, 039 Move 6 proc code (dilation of carotid artery w/stent that were missing) to MS-DRG 034, 035, 036034, 035, 036037, 038, 039
Pulmonary EmbolismRe-assign secondary diagnosis of I26.01, I26.02, I26.09 Re-title MS-DRG “Pulmonary Embolism w/MCC or Acute Cor Pulmonale”176175
Transcatheter Mitral Valve Repair w/ImplantMove endovascular supplement procedures. Create new MS-DRGs for endovascular non-supplement procedures.216-221, 228, 229, 273, 274266, 267 319, 320
Revision of Pacemaker LeadAdd 02H60JZ as non-procedure that impacts DRG assignmentNone260, 261, 262
Knee Proc w/PDx of InfectionAdd M00.9, A18.02, M01.X61, Mo1.X62, M01.X69, M71.061, M71.062, M71.069, M71.161, M71.162, M71.169 Remove several diagnoses from 485, 486, 487548, 549, 550485, 486, 487
Neuromuscular ScoliosisMove M41.40, M41.44, M41.45, M41.46, M41.47459, 460456, 457, 458
Secondary Scoliosis/KyphosisMove M41.50, M41.54, M41.55, M41.56, M41.57, M40.10, M40.14, M40.15 Diagnosis codes for cervical spine with be removed from 456, 457, 458459, 460456, 457, 458
Extracorporeal Shockwave LithotripsyDelete MS-DRGs 691, 692 Update titles for 693, 694691, 692693, 694
Other specified conditions affecting pregnancy, childbirth, and puerperium (O99.89)Re-classify as antepartum condition769 (w/OR) 776 (w/o OR)817, 818, 819 831, 832, 833
Abnormal finding on diagnostic imaging of other specified body structures (R93.89)Re-assign from MDC 5 to MDC 23MDC 5 (215 – 320)MDC 23 (939 – 951)


Changes to MS-DRGs 981 – 983 and 987 – 989


In addition to the proposed MS-DRG changes, CMS has also proposed numerous changes for ICD-10-CM/PCS codes that are assigned to MS-DRGs 981 – 983 and 987 – 989.   These proposed changes include the following:


  1. Gastrointestinal Stromal Tumors with excision of stomach and small intestine.   The GIST codes will be moved from MDC 8 to MDC 6 so that the MS-DRGs will shift to 326, 327, and 328.

  2. Peripheral Dialysis Catheters. The procedures for insertion, removal, or revision of peritoneal dialysis catheters will be moved to MDC 21 so that the assigned MS-DRGs will shift to 907, 908, and 909.

  3. Bone excision with pressure ulcers. The procedure codes for excision of sacrum, pelvic bones, and coccyx will be moved to MS-DRGs 579, 580, and 581.

  4. Lower extremity muscle and tendon excision. The diagnosis codes will be shifted to MDC 10.  Eight procedure codes will be assigned to MDC 10 to shift the MS-DRGs to 622, 623, 624.

  5. Kidney Transplant. The kidney transplant codes (0TY00Z0 and 0TY10Z0) will be moved to MS-DRG 264.    CMS stated that they are requested feedback regarding this proposal.

  6. Insertion of feeding device. Procedure code 0DH60UZ will be assigned to MDC 1 and 10.   If the principal diagnosis is from MDC 1, then the MS-DRG will shift to 040, 041, or 042.   If the principal diagnosis is from MDC 10, then the MS-DRG will shift to 628, 629, or 630.

  7. Basilic vein reposition in Chronic Kidney Disease (CKD). Three procedure codes will be assigned to MDC 11.   If the principal diagnosis is from MDC 11, then the MS-DRG will shift to 673, 674, or 675.

  8. Colon resection with fistula. Procedure code 0DTN0ZZ will be added to MDC 11.   With a principal diagnosis of N32.1, then the MS-DRG will shift to 673, 674, 675

  9. Finger cellulitis. The procedure codes for excision and resection of phalanx will be assigned to MDC 9 and the MS-DRG will shift to 579, 580, 581.

  10. Gastric band procedure complications/infections. Procedure codes 0DW64CZ and 0DP64CZ will be moved to MDC 6 and the MS-DRG will shift to 326, 327, or 328 with principal diagnosis K95.01 or K95.09.

  11. Occlusion of Left Renal Vein. Procedure codes 06LB3DZ to MDC 12 and MDC 13.   If male, the MS-DRG will shift to 715, 716, 717, or 718.   If female, the MS-DRG will shift to 749 or 750.

Financial Updates


The proposed rule begins with a summary of financial changes.    The Coding and Documentation Adjustment is proposed to be +0.5 percent.   The New Add-On Technology adjustment is projected to increase the spend by $110 million for FY20.  


The Readmission Reduction Program (RRP) is projected to save $550 million. The Value-Based Purchasing Program (VBP) will have $1.9 billion available for incentives to the applicable hospitals.   The Inpatient Quality Reporting program is projected to increase the cost to all hospitals by $83,266.


The national cost to charge (CCR) was proposed for nineteen areas:










































GroupCCR
Routine Days0.433
Intensive Days0.362
Drugs0.191
Supplies and Equipment0.301
Implantable Devices0.308
Therapy0.297
Laboratory0.109
Operating Room0.175
Cardiology0.099
Cardiac Catheterization0.106
Radiology0.140
MRI0.073
CT Scans0.035
Emergency Room0.154
Blood and Blood Products0.282
Other Services0.344
Labor and Delivery0.369
Inhalation Therapy0.151
Anesthesia0.077

New Technology Updates and New Applications


There were a number of New Technology Add-On Payments that were discussed. Three will be discontinued from FY19. These include Defitelio, Stelara, and ZINPLAVA. Nine will continue from FY19. The continued add-on payments include KYMRIAH/YESCARTA, VYXEOS, Vabomere, Remede, Zemdri, GIAPREZA, Cerebral Protection System, AquaBeam, and Andexxa.   

The following seventeen (17) are new requests for FY20: 










































































New RequestsTreatsPCS CodesStandardized Charge/Case
AZEDRAObenguane avid malignant and/or recurrent and/or unresectable pheochromocytoma & paragangliomaNone noted$1,078,631
CABLIVIAcquired thrombotic thrombocytopenia purpuraNone$145,543
CivaSheetLocalized tumorsNone$188,897
CONTEPOComplicated UTI (multi-drug resistant pathogen)None$71,333
DuraGraft Vascular Conduit SolutionProtect the endothelium of vein graft by mitigating ischemic reperfusion injuryXY0VX83$195,799
Eluvia Drug-Eluting Vascular Stent SystemPeripheral Atherosclerosis DiseaseApplication made$86,950
ELZONRISBlastic plasmacytoid dendritic cell neoplasmsNone$1,010,455
ErdafitinibLocally advanced or metastatic urothelial carcinomaApplication made$111,713
ErleadaNon-metastatic castration-resistant prostate cancerNone$76,901
SPRAVATO (Esketamine)Treatment Resistant DepressionNone – Nasal Spray$74,738
XOSPATA (Gilteritinib)Relapsed or refractory acute myeloid leukemiaNone$157,034
GammaTileBrain tumors00H004Z$253,876
Imipenem, Cilastatin, & Relebactam Injection (IMI/REL)Complicated intra-abdominal infections – susceptible gram-negative microorganismsApplication made$74,778
JAKAFI (Ruxolitinib)Acute graft vs. host diseaseNone$261,512
Supersaturated Oxygen (SSO2) Therapy (DownStream System)Acute myocardial infarctions5A0512C 5A0522C$144,364
T2 Bacteria Panel (T2 Bacterial Test Panel)BacteremiaNone$56,844 – $103,285
VENCLEXTAChronic lymphocytic leukemiaApplication madeNo information

The final rule is expected to be published the first week of August 2019 which will be effective Oct. 1, 2019.   

Some preliminary steps that can be taken include the following:


  1. Finance should review the changes and model the impacts to the facilities reimbursement levels.

  2. Review the New Technology Add-On changes and determine if any of the new applications will impact your facility. Ensure that these items are in the chargemaster.

  3. Review new diagnosis and procedure codes to determine if any documentation prompts or education is needed.

  4. Complete education with physicians and clinical documentation staff on the changes in the severity status as there are many big changes in this proposed rule.

  5. Update facility specific coding guidelines and provide education to the coding staff.

  6. Perform coding review in January 2020 to ensure that the new diagnosis and procedure codes are correctly assigned.

CMS is requesting comments regarding this proposal which are due by June 24, 2019.    The comments must reference CMS-1716-P and can be uploaded to http://www.regulations.gov or mailed to Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention:  CMS-1716-P, P.O. Box 8013, Baltimore, MD  21244-1850.


——————————————————


Photo courtesy of: ICD10 Monitor


Originally Published On: ICD10 Monitor


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