Each year, CMS makes changes to DRGs under the IPPS rule that affect how hospitals are reimbursed. Because IPPS hospitals are paid based on Medicare Severity Diagnosis Related Groups (MS-DRG), additions, deletions, or alterations to MS DRGs can affect how hospitals should submit claims to Medicare.

1. MS DRG Changes –
2018 recap and 2019 look ahead

2. Because IPPS hospitals are paid based on Medicare Severity
Diagnosis Related Groups (MS-DRG), additions, deletions, or
alterations to MS DRGs can affect how hospitals should
submit claims to Medicare.

3. 2018 MS DRG and
ICD 10 Changes

4. MS DRG changes in the 2018 final rule
• A reduction in the number of MS DRGs from 757 to 754.
• DRGs 984, 985 and 986 deleted.
• There were several DRG name changes to clarify the actual MS
DRG diagnosis codes.
• There were no new DRGs added to the list of MS-DRGs subject to
the post-acute care transfer policy (PACT). Additionally, there were
no MS-DRGs eliminated from the list. The list remains at 280
DRGS impacted by the rule.
• The special payment policy had DRGs 987, 988 and 989 added
and now has 40 MS DRGs on the list that qualify for special
payments.

5. ICD 10 changes in the 2018 final rule
• 324 new ICD-10-CM diagnosis codes proposed for fiscal 2018
• 3,151 new ICD-10-PCS procedure codes
• 38 invalid ICD-10-CM diagnosis codes
• 641 invalid ICD-10-PCS procedure codes
• 43 revised ICD-10-CM diagnosis code titles
• 1,808 revised ICD-10-PCS procedure code titles

6. 2019 proposed
changes

7. The 2019 proposed IPPS final rule issued in
April 2018 suggests…
• MS DRGs increased from 754 to 759
• DRGs 685,765, 766, 767, 774, 775, 777, 778, 780, 781, 782 are
deleted
• DRGs 783, 784, 785, 786, 787, 788, 797, 798, 799, 805, 806,
807, 817, 818, 819, 831, 832 and 833 are added.
• 435 ICD 10 code changes
• 247 new codes
• 139 revised codes
• 49 deleted codes

8. The increase of the MS-DRGs are for vaginal delivery, Cesarean
Section procedures and antepartum care and procedures.

9. Most of the newly proposed ICD-10-CM codes are
found in Neoplasms Diseases of the eye and adnexa and injury,
poisoning and certain other consequences of external causes.

10. There are proposals to revise the MS-DRG
classifications based on the additional ICD-
10 codes previously referenced, but do not
impact the number of overall DRGs or the
ones impacted by the transfer policy.
For 2019, there are no
additional DRGs
that will be impacted
by the transfer policy.

11. Proposed MS DRG
changes affecting
hospice reimbursement

12. In 2018, providers are entitled to the
full MS DRG when 50 or 51 is used.
Should the provisions in the 2019
proposed rule survive, providers will
receive a per diem payment instead.
As established in the
Bipartisan Budget Act of 2018,
discharges to hospice services
provided by a hospice program
will be impacted by the
post-acute care transfer policy.

13. MS DRG changes can affect how Transfer DRG
underpayments and overpayments are properly
recovered.
Without displacing or disrupting a current review
vendor or internal process, BESLER can provide a
secondary validation of impacted transfer claims
to ensure you are identifying all potential
underpayments and overpayments.
*HFMA staff and volunteers determined that Transfer DRG Revenue Recovery Service has met certain criteria developed under
the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this service.
Learn how to
recover more
Transfer DRG
underpayments
besler.com/transfer-drg-revenue-recovery