It is that time of year again where the new codes for the next fiscal year and IPPS Final Rule are available. In this post, we will summarize the biggest changes for ICD-10-CM codes, ICD-10-PCS codes and IPPS changes for FY2024.
ICD-10-CM Summary and Significant Changes
For FY2024 we have:
74,044 total ICD-10-CM codes
395 new codes
25 deleted codes
13 revised codes
Most of the changes impacting the total number of new codes occurred in the external causes of morbidity and musculoskeletal system chapters. Also, many of the diagnosis changes involved expanded somewhat obscure condition codes, such as adding codes for sites for desmoid tumors, adding a choice of ‘with dactylitis” for all sickle cell disease codes and expanding types of metabolic syndrome codes. There are many other changes like this. Coders are encouraged to continue to utilize the index for coding to arrive at these newer expanded codes and to research the medical record for supportive documentation. Codes are only going to get more specific and accurate documentation is a must.
There were some updates to the ICD-10-CM index involving cerebrovascular accident entries, arteriosclerosis with infarction entries added, and updates to correct code assignments such as those under Bronchitis, due to fumes and vapors. There were other index additions and changes as well. The following index and tabular changes are rather significant:
- Cachexia. The MAIN index entry for Cachexia was changed from R64 Cachexia to E43, Unspecified severe protein-calorie malnutrition. New entries under Cachexia are “Due to malnutrition, R64” and “due to underlying condition, new code E88.A, Wasting disease (syndrome) due to underlying condition were added.” This is a significant change!
- Elevated Troponins. The index entry was changed from R77.8 to R79.89, Other specified abnormal findings of blood chemistry. This now aligns with Coding Clinic 2019 advice.
- Benign neoplasm of other ill-defined parts of digestive system. There are new codes for familial adenomatous polyposis and benign neoplasm of GIs sites that are ill defined such as intestine NOS or spleen.
- Parkinson’s disease codes expanded. G20 was expanded to identify the disease with or without dyskinesia and with or without fluctuations.
- Resistant hypertension has a new code I1A.0 with a code first note.
- Coronary microvascular dysfunction. Multiple new codes that include coronary microvascular dysfunction/disease were added to include new code for MINOCA.
- Excludes1 note changed to excludes2 note at codes J43 Emphysema and J44 COPD. In addition, many excludes1 notes were changed to excludes2 notes including under K63.5 polyp of colon.
- Osteoporosis codes (all types) expanded to accommodate more sites.
- Additional codes for child custody status and caregiver noncompliance added.
- Many new external cause codes for foreign body entering through natural orifice. These codes were added to differentiate between specific foreign bodies such as battery, button, ear buds, and many other objects entering through a natural orifice.
- OCG changes. Guidelines addressing new codes were added such as encounter for HIV prophylactic measures resistant hypertension were added. No changes in the basic information.
ICD-10-PCS Codes Summary of Major Changes
For FY2024 we have:
78,603 total ICD-10-PCS codes
78 new codes
5 deleted codes
14 revised titles
Changes this year for procedure codes are mostly in the medical surgical section and the new technology section. Coders must always be aware of body part value definition updates and additions along with device and substance additions to the tables. Usually these are added to the index as well. There were many added as usual this year.
- Aortix™ Short-term External Heart Assist System. New codes created for Insertion, Removal and Revision of the Aortix™ System. Created a new device character R for Short term External Heart Assist System. Assistance with cardiac output using Impella pump, continuous must be coded with insertion if performed.
- Magnetic Lengthening Device for Esophagus. Three new body parts, esophagus, upper, middle, and lower added to Insertion table along with “Magnetic lengthening device” for this procedure.
- Added Mediastinum Defibrillator Lead. This was added to allow coding of extravascular leads used such as mediastinal for extravascular devices.
- Intubated Prone Positioning. This was added to Respiratory Assistance as a qualifier. This is a method typically done for COVID-19 patients.
- Many New Technology Codes were added to Section X. These include ablation of renal sympathetic nerves, insertion of SVC or IVC bioprosthetic valves, implanting bioprosthetic femoral VENOUS valves, Implantation of CONDUIT to short term external heart assist system (2 codes needed), Supplement of coronary arteries or upper veins with VEST system used during CABG, and insertion of leadless dual chamber pacemaker. Other new technology was added as well. Many new substances were added and some of these will also be paid as New Technology Add on Payments (NTAP) as well as some new devices. Coding X Section codes is crucial!
IPPS Changes for 2024
The IPPS Final Rule 2024 was out on August 1, 2023. Acute care hospitals that report quality data and that are meaningful users of EHRs will receive approximately a 3.1% increase in Medicare operating rates. This reflects the projected hospital market basket update of 3.3 percent reduced by a 0.2 percentage point productivity adjustment. Hospitals that do not submit quality data would lose 1/4 of the market basket update (of 3.1% as above) This would be 2.33% increase only. Hospitals that are not meaningful users of EHRs will be subject to a 3/4 or -0.75 reduction of the market basket for FY 2024. CMS is projecting that with the 3.1% increase and other changes to IPPS policies it will increase total IPPS payments in FY2024 by roughly $2.2 billion which includes increase in operating payments but decrease in new technology payments.
The “New COVID-19 Treatments Add-on Payments” (NCTAP) end on 9/30/23.
Quality measure additions and changes summary are included in our course on IPPS Changes for FY2024.
Of note, CMS is changing “Homelessness” SDOH codes (Z59.00, Z59.01, Z59.02) from Non-CC to CC. CMS is recognizing homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting. CMS is also considering including social determinants of health (SDOH) as part of new quality measures.
In the Final Rule, CMS created 15 new MS-DRGs and deleted 16 MS-DRGS. This is because some existing MS-DRGS were expanded to include with CC, with MCC, and without CC/MCC. The majority of MS-DRG changes are in MDC-5, Diseases and Disorders of the Circulatory System. There were several reassignments of MS-DRGs for procedures that make more sense. One example is changing central and retinal branch artery occlusion diagnosis codes from MS-DRG 123 Neurological Eye disorders to MS-DRGs 124 and 125 Disorders of eye with MCC or thrombolytic administration or Without MCC along with adding procedure code 3W0—17 for thrombolytic agent to DRG 124.
In another change, CMS deleted old MS-DRGs 246-249 for Percutaneous CV procedures involving bare stents and drug eluting stents and eliminated the division based on type of stents. The new MS-DRGS are 321/322 Percutaneous CV procedures with intraluminal device with MCC OR 4+ arteries/intraluminal devices or without MCC.
In all, there were 10 changes made similar to the above two regarding MS-DRGs. As for unrelated MS-DRGS, five different procedures were moved OUT OF MS-DRGS 981-983 into their proper chapter MS-DRGs.
The MCC and CC lists were only modified to accommodate the new codes and expansion of old codes. There were no existing codes added or removed from the lists with the exception of adding Z59.00 codes for homelessness as CCs.
As for New Technology Add on Payments (NTAP) there were 11 NTAP payments continued from last year. There was a total of 19 new approvals for NTAP payments for 2024 bringing the total to 30. In HIA’s course IPPS Changes for FY2024 we have a complete listing with information about the new technology, codes applicable and payment for coders to reference.
Our three new courses below are available for purchase on HIALearn.com! You don’t want to miss taking these courses. These courses provide much more detail of ALL of the changes for FY2024 and include explanations, photos, and descriptions to assist the coder in applying the new codes.
New ICD-10-CM Diagnosis Codes and Change FY2024 2.5 CEUs AHIMA; 2.5 CEUs AAPC
New ICD-10-PCS Procedure Codes and Changes FY2024 2.0 CEUs AHIMA
IPPS Changes for FY 2024 2.0 CEUs AHIMA
CPT Changes for CY2024 (AVAILABLE JANUARY 2024)
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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