IPPS Final Rule: Key Updates for FY 2022 by Panacea Healthcare Solutions

IPPS Final Rule: Key Updates for FY2022 Presented by: Coding and Documentation Division Panacea Healthcare Solutions Software. Consulting. Education. Results.

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Agenda

01 02

ICD-10-CM FY 2022 • •

Additions/Changes/Revisions to Official Guidelines Discuss Code Changes for FY 2022

ICD-10-CM/PCS Code Updates Expanded

ICD-10-PCS FY 2022

Changes in MS-DRGs

• • •

Additions/Changes/Revisions to Official Guidelines Discuss Code Changes for FY 2022 Body Part Key Update

Groupings OR to Non-OR Procedures Extensive OR to Non-extensive OR Procedures

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CC/MCC Designation Changes

Technology to Assist w/CC/MCCs

Complimentary CC/MCC Trend Report for Focused Audits & Education

Q&A

Sandy Brewton RHIT, CCS, CHCA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Healthcare Consultant

Presenter

In Sandy’s nearly 30-year career in healthcare, including 10 years of pediatric experience, she has conducted numerous coding and documentation reviews and provided education for coders, physicians and facility leadership. In addition to inpatient DRG reviews, she has provided audit and education services for outpatient facility and professional services of providers.

IPPS FY22 Final Rule Home Page

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FY2022 Revisions Additions Deletions ICD-10-CM Guidelines

ICD-10-CM FY 2022 Overview Over 200 Diagnosis Code Changes 159 additions 32 deletions 20 revisions

Total codes FY2022 72,748

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Guideline changes and additions General guidelines Chapter-specific

Guideline Changes Format ▪ Deletions are seen with strikethrough ▪ Italics are used to indicate revisions to headings ▪ Additions/New Guidelines are bolded. ▪ Find the 2022 ICD-10-CM Official Guidelines for Coding and Reporting here: https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf

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Level of Detail in Coding General Guideline I.B.2. ▪ Diagnosis codes are to be used and reported at their highest number of characters available and to the highest level of specificity documented in the medical record. ▪ ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth characters and/or sixth characters, which provide greater detail. ▪ A three-character code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.

Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services F. Level of Detail in Coding 3. Highest level of specificity

Code to the highest level of specificity when supported by the medical record documentation.

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General Guidelines General Guideline I.B.3. 3. Code or codes from A00.0 through T88.9, Z00-Z99.8, U00-U85 ▪ The appropriate code or codes from A00.0 through T88.9, Z00-Z99.8, and U00-U85 must be used to identify diagnoses, symptoms, conditions, problems, complaints or other reason(s) for the encounter/visit.

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General Guidelines: Laterality ▪ Guideline I.B.13. ▪ When laterality is not documented by the patient’s provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting medical record documentation regarding the affected side, the patient’s attending provider should be queried for clarification. Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.

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General Guidelines: Other Clinicians’ Documentation Guideline I.B.14. 14. Documentation by Clinicians Other than the Patient's Provider ▪ Code assignment is based on the documentation by the patient's provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). There are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). In this context, “clinicians” other than the patient’s provider refer to healthcare professionals permitted, based on regulatory or accreditation requirements or internal hospital policies, to document in a patient’s official medical record.

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General Guidelines: Other Clinicians’ Documentation (cont) Guideline I.B.14. (continued) These exceptions include codes for: ▪ Body Mass Index (BMI) ▪ Depth of non-pressure chronic ulcers ▪ Pressure ulcer stage ▪ Coma scale ▪ NIH stroke scale (NIHSS) ▪ Social determinants of health (SDOH) ▪ Laterality ▪ Blood alcohol level

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General Guidelines: Other Clinicians’ Documentation (cont) Guideline I.B.14. (continued) ▪ This information is typically, or may be, documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI, a nurse often documents the pressure ulcer stages, and an emergency medical technician often documents the coma scale). However, the associated diagnosis (such as overweight, obesity, acute stroke, pressure ulcer, or a condition classifiable to category F10, Alcohol related disorders) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification. ▪ The BMI, coma scale, NIHSS, blood alcohol level codes and codes for social determinants of health should only be reported as secondary diagnoses.

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General Guidelines: Sign/Symptom/Unspecified Codes Guideline I.B.18 ▪ Sign/symptom and “unspecified” codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter. ▪ As stated in the introductory section of these official coding guidelines, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated. Software. Consulting. Education. Results.

General Guidelines: Sign/Symptom/Unspecified Codes (cont) Guideline I.B.18 (continued) ▪ If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). Unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or conduct medically unnecessary diagnostic testing in order to determine a more specific code.

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General Guidelines: Healthcare Encounters in Hurricane Aftermath Guideline I.B.19. ▪ d. Use of Z codes Z codes (other reasons for healthcare encounters) may be assigned as appropriate to further explain the reasons for presenting for healthcare services, including transfers between healthcare facilities, or provide additional information relevant to a patient encounter. The ICD-10-CM Official Guidelines for Coding and Reporting identify which codes maybe assigned as principal or first-listed diagnosis only, secondary diagnosis only, or principal/first-listed or secondary (depending on the circumstances).

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Guidelines: Chapter 1 ▪ 2) a. Human Immunodeficiency Virus (HIV) Infection • (i) History of HIV managed by medication If a patient with documented history of HIV disease is currently managed on antiretroviral medications, assign code B20, Human immunodeficiency virus [HIV] disease. Code Z79.899, Other long term (current) drug therapy, may be assigned as an additional code to identify the long-term (current) use of antiretroviral medications.

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Guidelines: Chapter 1 ▪ g. Coronavirus Infections ▪ 1) (g) Signs and symptoms without definitive diagnosis of COVID-19 ▪ For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: • R05.1, Acute cough, or R05.9, Cough, unspecified • R06.02 Shortness of breath • R50.9 Fever, unspecified

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Guidelines: Chapter 1 ▪ g. Coronavirus Infections ▪ 1) (j) Follow-up visits after COVID-19 infection has resolved ▪ For individuals who previously had COVID-19, without residual symptom(s) or condition(s), and are being seen for follow-up evaluation, and COVID-19 test results are negative, assign codes Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm, and Z86.16, Personal history of COVID-19. For follow-up visits for individuals with symptom(s) or condition(s) related to a previous COVID-19 infection, see guideline I.C.1.g.1.m. ▪ See Section I.C.21.c.8, Factors influencing health states and contact with health services, Follow-up

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Guidelines: Chapter 1 ▪ g. Coronavirus Infections ▪ 1) (l) Multisystem Inflammatory Syndrome

▪ If an individual with a history of COVID-19 develops MIS, assign codes M35.81, Multisystem inflammatory syndrome, and U09.9, Post COVID-19 condition, unspecified. ▪ 1) (m) Post COVID-19 Condition ▪ For sequela of COVID-19, or associated symptoms or conditions that develop following a previous COVID-19 infection, assign a code(s) for the specific symptom(s) or condition(s) related to the previous COVID-19 infection, if known, and code U09.9, Post COVID-19 condition, unspecified. Code U09.9 should not be assigned for manifestations of an active (current) COVID-19 infection. ▪ If a patient has a condition(s) associated with a previous COVID-19 infection and develops a new active (current) COVID-19 infection, code U09.9 may be assigned in conjunction with code U07.1, COVID-19, to identify that the patient also has a condition(s) associated with a previous COVID-19 infection. Code(s) for the specific condition(s) associated with the previous COVID-19 infection and code(s) for manifestation(s) of the new active (current) COVID-19 infection should also be assigned.

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Guidelines: Chapter 2 ▪ Neoplasms ▪ 2) (s) Breast Implant Associated Anaplastic Large Cell Lymphoma ▪ Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a type of lymphoma that can develop around breast implants. Assign code C84.7A, Anaplastic large cell lymphoma, ALK-negative, breast, for BIAALCL. ▪ Do not assign a complication code from chapter 19.

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Guidelines: Chapter 4 ▪ a. Diabetes mellitus ▪ 3) Diabetes mellitus and the use of insulin, oral hypoglycemics, and injectable non-insulin drugs ▪ If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11-, Type 2 diabetes mellitus, should be assigned. Additional code(s) should be assigned from category Z79 to identify the long-term (current) use of insulin, oral hypoglycemic drugs, or injectable non-insulin antidiabetic, as follows: ➢ If the patient is treated with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and code Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned. ➢ If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long term (current) use of insulin, and Z79.899, Other long term (current) drug therapy.

➢ If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long term (current) use of oral hypoglycemic drugs, and Z79.899, Other long term (current) drug therapy.

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Guidelines: Chapter 4 ▪ a. Diabetes mellitus ▪ 6) Secondary diabetes mellitus ▪ (a) Secondary diabetes mellitus and the use of insulin, oral hypoglycemic drugs, or injectable non-insulin drugs ▪ For patients with secondary diabetes mellitus who routinely use insulin, oral hypoglycemic drugs, or injectable non-insulin drugs, additional code(s) from category Z79 should be assigned to identify the long-term (current) use of insulin, oral hypoglycemic drugs, or non-injectable non-insulin drugs as follows: ▪ If the patient is treated with both oral medications and insulin, both code Z79.4, Long term (current) use of insulin, and code Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned.

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Guidelines: Chapter 5 ▪ b. Mental and behavioral disorders due to psychoactive substance use ▪ 3) Psychoactive Substance Use, Unspecified As with all other unspecified diagnoses, the codes for unspecified psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-, F18.9-, F19.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). These codes are to be used only when the psychoactive substance use is associated with a substance related disorder (chapter 5 disorders such as sexual dysfunction, sleep disorder, or a mental or behavioral disorder) or medical condition, and such a relationship is documented by the provider.

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Guidelines: Chapter 5 • b. Mental and behavioral disorders due to psychoactive substance use 4) Medical Conditions Due to Psychoactive Substance Use, Abuse and Dependence

Medical conditions due to substance use, abuse, and dependence are not classified as substance-induced disorders.

Assign the diagnosis code for the medical condition as directed by the Alphabetical Index along with the appropriate psychoactive substance use, abuse or dependence code. For example, for alcoholic pancreatitis due to alcohol dependence, assign the appropriate code from subcategory K85.2, Alcohol induced acute pancreatitis, and the appropriate code from subcategory F10.2, such as code F10.20, Alcohol dependence, uncomplicated. It would not be appropriate to assign code F10.288, Alcohol dependence with other alcohol-induced disorder.

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Guidelines: Chapter 5 • b. Mental and behavioral disorders due to psychoactive substance use

5) Blood Alcohol Level

Medical conditions due to substance use, abuse, and dependence are not classified as substance-induced disorders.

The blood alcohol level does not need to be documented by the patient’s provider in order for it to be coded.

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Guidelines: Chapter 12 a. Pressure ulcer stage codes

2) Unstageable pressure ulcers

Assignment of the code for unstageable pressure ulcer (L89.--0) should be based on the clinical documentation. These codes are used for pressure ulcers whose stage cannot be clinically determined (e.g., ulcer is covered by eschar or has been treated with a skin or muscle graft). This code should not be confused with the codes for unspecified stage (L89.--9). When there is no documentation regarding the stage of the pressure ulcer, assign the appropriate code for unspecified stage (L89.-- 9).

If during an encounter, the stage of an unstageable pressure ulcer is revealed after debridement, assign only the code for the stage revealed following debridement.

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Guidelines: Chapter 15 A. General Rules for Obstetric Cases 3) Final character for trimester ▪ Whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned. When the classification does not provide an obstetric code with an “in childbirth” option, it is appropriate to assign a code describing the current trimester.

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Guidelines: Chapter 18

e. Coma

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Code R40.20, Unspecified coma, may be assigned in conjunction with codes for any medical condition.

Do not report codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically induced coma or a sedated patient.

Guidelines: Chapter 18 e. Coma 1) Coma Scale

The coma scale codes (R40.21- to R40.24-) can be used in conjunction with traumatic brain injury codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes should be sequenced after the diagnosis code(s).

These codes, one from each subcategory, are needed to complete the scale. The 7th character indicates when the scale was recorded. The 7th character should match for all three codes.

At a minimum, report the initial score documented on presentation at your facility. This may be a score from the emergency medicine technician (EMT) or in the emergency department. If desired, a facility may choose to capture multiple coma scale scores.

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Guidelines: Chapter 18 e. Coma 1) Coma Scale

Assign code R40.24-, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s).

If multiple coma scores are captured within the first 24 hours after hospital admission, assign only the code for the score at the time of admission. ICD-10-CM does not classify coma scores that are reported after admission but less than 24 hours later.

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Guidelines: Chapter 21 D. Coding of Burns and Corrosions 6) Burns and corrosions classified according to extent of body surface involved • Assign codes from category T31, Burns classified according to extent of body surface involved, or T32, Corrosions classified according to extent of body surface involved, for acute burns or corrosions when the site of the burn or corrosion is not specified or when there is a need for additional data. It is advisable to use category T31 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units. It is also advisable to use category T31 as an additional code for reporting purposes when there is mention of a third degree burn involving 20 percent or more of the body surface. • Codes from categories T31 and T32 should not be used for sequelae of burns or corrosions. Software. Consulting. Education. Results.

Guidelines: Chapter 21

b. Z Codes Indicate a Reason for an Encounter or Provide Additional Information about a Patient Encounter

Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed.

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Guidelines: Chapter 21 c. Categories of Z Codes 4) History (of) • The reason for the encounter (for example, screening or counseling) should be sequenced first and the appropriate personal and/or family history code(s) should be assigned as additional diagnos(es).

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Guidelines: Chapter 21 ▪ c. Categories of Z Codes ▪ 9) Donor Codes in category Z52, Donors of organs and tissues, are used for living individuals who are donating blood or other body tissue. These codes are only for individuals donating for others, not for selfdonations. They are not used to identify cadaveric donations.

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▪ c. Categories of Z Codes ▪ 9) Donor Codes in category Z52, Donors of organs and tissues, are used for living individuals who are donating blood or other body tissue. These codes are only for individuals donating for others, not as well as for self-donations. They are not used to identify cadaveric donations.

Guidelines: Chapter 22 ▪ c. Categories of Z Codes ▪ 10) Counseling ▪ Z71 Persons encountering health services for other counseling and medical advice, not elsewhere classified ▪ Code Z71.85, Encounter for immunization safety counseling, is to be used for counseling of the patient or caregiver regarding the safety of a vaccine. This code should not be used for the provision of general information regarding risks and potential side effects during routine encounters for the administration of vaccines.

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Guidelines: Chapter 21 ▪ c. Categories of Z Codes ▪ 14) Miscellaneous Z Codes ▪ The miscellaneous Z codes capture a number of other health care encounters that do not fall into one of the other categories. Some of these codes identify the reason for the encounter; others are for use as additional codes that provide useful information on circumstances that may affect a patient’s care and treatment.

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Guidelines: Chapter 21 ▪ c. Categories of Z Codes ▪ 17) Social Determinants of Health Codes describing social determinants of health (SDOH) should be assigned when this information is documented. For social determinants of health, such as information found in categories Z55-Z65, Persons with potential health hazards related to socioeconomic and psychosocial circumstances, code assignment may be based on medical record documentation from clinicians involved in the care of the patient who are not the patient’s provider since this information represents social information, rather than medical diagnoses. ▪ For example, coding professionals may utilize documentation of social information from social workers, community health workers, case managers, or nurses, if their documentation is included in the official medical record.

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Guidelines: Chapter 21

▪ Patient self-reported documentation may be used to assign codes for social determinants of health, as long as the patient self-reported information is signed-off by and incorporated into the medical record by either a clinician or provider.

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Diagnosis Code Changes Additions, Deletions and Revisions for FY 2022

FY2022 New Diagnosis Codes: Chapter 1 ▪ A79.82

Anaplasmosis [A. phagocytophilum]

Anaplasmosis: • Tick-borne illness transmitted via bite from infected tick • 1 to 2 week incubation period • Can result in thrombocytopenia, anemia, respiratory failure, other organ failure – Can be fatal

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FY2022 New Diagnosis Codes: Chapter 2 Bilateral ovarian cancer ▪ C56.3 Malignant neoplasm of bilateral ovaries ▪ C79.63 Secondary malignant neoplasm of bilateral ovaries

Breast implant related lymphoma ▪ C84.7A Anaplastic large cell lymphoma, ALK-negative, breast • Abbreviation: BIA-ALCL • Rare form of T-cell lymphoma • Cancer of the immune system

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FY2022 New Diagnosis Codes: Chapter 3 Anemia ▪ New: D55.21 Anemia due to pyruvate kinase deficiency • PK deficiency anemia • Pyruvate kinase deficiency anemia ▪ New: D55.29 Anemia due to other disorders of glycolytic enzymes • Hexokinase deficiency anemia • Triose-phosphate isomerase deficiency anemia

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FY2022 New Diagnosis Codes: Chapter 3 Thrombocytosis ▪ D75.838 Other thrombocytosis ▪ D75.839 Thrombocytosis, unspecified

Hereditary Alpha Tryptasemia ▪ D89.44 Hereditary alpha tryptasemia

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FY2022 New Diagnosis Codes: Chapter 4 Niemann-pick Disease (NPD) Type A/B ▪ E75.244 Niemann-Pick disease type A/B ▪ Extremely rare disease • Fewer than 1000 cases per year in the U.S. • Genetic condition • Four main types: A, B, C1, C2

▪ Type A: Usually onset in infancy, all affected children have a cherry red spot eye abnormality. Death usually in early childhood. ▪ Type B: Usually presents mid-childhood, one third have the cherry red spot eye abnormality. Usually survive into adulthood.

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FY2022 New Diagnosis Codes: Chapter 5

Depression

F32.A Depression, unspecified

Default previously F32.9, Major depressive disorder, single episode, unspecified

Includes: Depression NOS Depressive disorder NOS

FINALLY!

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FY2022 Diagnosis Codes: Chapter 5 Intellectual Disabilities

▪ Deleted:

F78

▪ New: ▪ New:

F78.A1 SYNGAP1-related intellectual disability F78.A9 Other genetic related intellectual disability

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Other intellectual disabilities

FY2021 Diagnosis Codes: Chapter 6 Early-onset cerebellar ataxia ▪ G04.82 Acute flaccid myelitis Cervicogenic Headache ▪ New: G44.86 Cervicogenic headache Spelling Error Correction ▪ Revise from: G71.20 Congenital myopathy, unspecifed ▪ Revise to: G71.20 Congenital myopathy, unspecified

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FY2022 New Diagnosis Codes: Chapter 6 Toxic Encephalopathy/Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS) ▪ Deleted: G92

Toxic encephalopathy

▪ New:

G92.00 Immune effector cell-associated neurotoxicity syndrome, grade unspecified

▪ New:

G92.01 Immune effector cell-associated neurotoxicity syndrome, grade 1

▪ New:

G92.02 Immune effector cell-associated neurotoxicity syndrome, grade 2

▪ New:

G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3

▪ New:

G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4

▪ New:

G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5

▪ New:

G92.8

Other toxic encephalopathy

▪ New:

G92.9

Unspecified toxic encephalopathy

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FY2022 New Diagnosis Codes: Chapter 9 Non-ischemic Myocardial Injury ▪ New: I5A Non-ischemic myocardial injury (non-traumatic) • Includes: – Acute (non-ischemic) myocardial injury – Chronic (non-ischemic) myocardial injury – Unspecified (non-ischemic) myocardial injury • Note: Traumatic myocardial injury categorized in S26.- (injury of heart) ▪ Need for clinicians to distinguish etiology of myocardial infarction • Non-ischemic vs. another myocardial infarction subtype (1-5) – Type 1 = spontaneous related to ischemia – Type 2 = secondary to ischemia 2/2 increased O2 demand o decreased O2 supply – Type 3 = Sudden unexpected cardiac death – Type 4a, 4b, 4c = Associated with PTCA or stent thrombosis – Type 5 = Associated with cardiac surgery (i.e., CABG)

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FY2022 Diagnosis Coding Convention Change: Chapter 9 ▪ Ischemic Heart Disease (I20.- to I25.-) ▪ Added: Code also the presence of hypertension (I10-I16) ▪ Deleted: Use Additional code to identify presence of hypertension (I10-I16)

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FY2022 New Diagnosis Codes: Chapter 11 Other specified diseases of esophagus ▪ Deleted: K22.8 Other specified diseases of esophagus ▪ Add: K22.81 Esophageal polyp ▪ Add: K22.82 Esophagogastric junction polyp ▪ Add: K22.89 Other specified disease of esophagus

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FY2021 New Diagnosis Codes: Chapter 11 ▪ Gastric intestinal metaplasia K31.A0 Gastric intestinal metaplasia, unspecified K31.A11 Gastric intestinal metaplasia without dysplasia, involving the antrum K31.A12 Gastric intestinal metaplasia without dysplasia, involving the body (corpus) K31.A13 Gastric intestinal metaplasia without dysplasia, involving the fundus K31.A14 Gastric intestinal metaplasia without dysplasia, involving the cardia K31.A15 Gastric intestinal metaplasia without dysplasia, involving multiple sites K31.A19 Gastric intestinal metaplasia without dysplasia, unspecified site K31.A21 Gastric intestinal metaplasia with low grade dysplasia K31.A22 Gastric intestinal metaplasia with high grade dysplasia K31.A29 Gastric intestinal metaplasia with dysplasia, unspecified

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Gastric Intestinal Metaplasia (GIM) ▪ Definition: Replacement of the surface of the antral gastric mucosa by intestinal mucosa consisting of Paneth, goblet and absorptive cells.

▪ GIM is a precursor lesion in the pathway to gastric cancer ▪ Regional prevalence of GIM closely correlates with the incidence of gastric cancer worldwide ▪ Risk Factors: • History of H. pylori • Race/ethnicity • Immigration status • Age • Family history • Other environmental factors https://commons.wikimedia.org/wiki/File:Gastric_intestinal_metaplasia,_intermed._mag.jpg

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FY 2022 New Diagnosis Codes: Chapter 12 ▪ Contact Dermatitis L24.A Irritant contact dermatitis due to friction or contact with body fluids

▪ L24.A0 Irritant contact dermatitis due to friction or contact with body fluids, unspecified ▪ L24.A1 Irritant contact dermatitis due to saliva ▪ L24.A2 Irritant contact dermatitis due to fecal, urinary or dual incontinence ▪ L24.A9 Irritant contact dermatitis due friction or contact with other specified body fluids L24.B Irritant contact dermatitis related to stoma or fistula ▪ L24.B0 Irritant contact dermatitis related to unspecified stoma or fistula ▪ L24.B1 Irritant contact dermatitis related to digestive stoma or fistula

▪ L24.B2 Irritant contact dermatitis related to respiratory stoma or fistula ▪ L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula Software. Consulting. Education. Results.

FY2021 New Diagnosis Codes: Chapter 13 Thrombotic microangiopathy ▪ Deleted: M31.1 Thrombotic microangiopathy ▪ Add: ▪ Add: ▪ Add:

M31.10 Thrombotic microangiopathy, unspecified M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA] M31.19 Other thrombotic microangiopathy

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Hematopoietic Stem Cell Transplantation Associated Thrombotic Microangiopathy (HSCT-TMA) Also known as Transplant-Associated Thrombotic Microangiopathy(TA-TMA) Rare, but serious condition affecting multiple systems, and often fatal complication of hematopoietic stem cell transplantation related to conditioning regimens, immunosuppressive drugassociated toxicity and infection. HSCT-TMA occurs often with other diagnoses (example: graft vs. host disease, diffuse alveolar hemorrhage, hepatic venoocclusive disease) and is typically caused by the hematopoietic stem cell transplant procedure

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FY2022 Revised Codes: Chapter 13 SICCA Syndrome to SJOGREN Syndrome

▪ REVISED subcategory title and code titles from Sicca Syndrome -> Sjogren Syndrome ▪ M35.00 Sicca Syndrome unspecified, ▪ M35.01 Sicca syndrome w/keratoconjunctivitis ▪ M35.02 Sicca syndrome w/lung involvement ▪ M35.03 Sicca syndrome w/myopathy

▪ M35.04 Sicca syndrome w/tubulo-interstitial nephropathy ▪ M35.09 Sicca syndrome w/other organ involvement to Sjogren Syndrome

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New Codes: ▪ M35.05 Sjogren syndrome with inflammatory arthritis

▪ M35.06 Sjogren syndrome with peripheral nervous system involvement ▪ M35.07 Sjogren syndrome with central nervous system involvement ▪ M35.08 Sjogren syndrome with gastrointestinal involvement ▪ M35.0A Sjogren syndrome with glomerular disease ▪ M35.0B Sjogren syndrome with vasculitis ▪ M35.0C Sjogren syndrome with dental involvement

FY2022 New Diagnosis Codes: Chapter 13 Axial Spondyloarthritis M45.A Non-radiographic axial spondyloarthritis

▪ M45.A0 Non-radiographic axial spondyloarthritis of unspecified sites in spine ▪ M45.A1 Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region ▪ M45.A2 Non-radiographic axial spondyloarthritis of cervical region ▪ M45.A3 Non-radiographic axial spondyloarthritis of cervicothoracic region ▪ M45.A4 Non-radiographic axial spondyloarthritis of thoracic region ▪ M45.A5 Non-radiographic axial spondyloarthritis of thoracolumbar region ▪ M45.A6 Non-radiographic axial spondyloarthritis of lumbar region ▪ M45.A7 Non-radiographic axial spondyloarthritis of lumbosacral region

▪ M45.A8 Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region ▪ M45.AB Non-radiographic axial spondyloarthritis of multiple sites in spine

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FY2022 New Diagnosis Codes: Chapter 13 Low back pain M54.5 Low back pain ▪ M54.50 Low back pain, unspecified • Includes: – Loin pain – Lumbago NOS

▪ M54.51 Vertebrogenic low back pain • Includes: – Low back vertebral endplate pain

▪ M54.59 Other low back pain

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FY2022 New Diagnosis Codes: Chapter 16 Abnormal Findings on Neonatal Screening New Code: P00.82 Newborn affected by (positive) maternal group B streptococcus (GBS) colonization Deleted:

P09

Abnormal findings on neonatal screening

New Codes: ▪ P09.1

Abnormal findings on neonatal screening for inborn errors of metabolism

▪ P09.2

Abnormal findings on neonatal screening for congenital endocrine disease

▪ P09.3

Abnormal findings on neonatal screening for congenital hematologic disorders

▪ P09.4

Abnormal findings on neonatal screening for cystic fibrosis

▪ P09.5

Abnormal findings on neonatal screening for critical congenital heart disease

▪ P09.6

Abnormal findings on neonatal screening for neonatal hearing loss

▪ P09.8

Other abnormal findings on neonatal screening

▪ P09.9

Abnormal findings on neonatal screening, unspecified

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FY2021 New Codes: Chapter 18 Cough ▪ Deleted: R05 Cough New Codes ▪ R05.1 Acute cough ▪ R05.2 Subacute cough ▪ R05.3 Chronic cough ▪ R05.4 Cough syncope ▪ R05.8 Other specified cough ▪ R05.9 Cough, unspecified

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FY2022 New Diagnosis Codes: Chapter 18 Deleted: R35.8 Other polyuria New Codes ▪ R35.81 Nocturnal polyuria ▪ R35.89 Other polyuria Polyuria Nocturnal Polyuria

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Making too much urine (not time specific) Making too much urine at night

FY2022 New Diagnosis Codes: Chapter 18 •New Code R45.88 Non-suicidal self-harm (non-suicidal self injury) • Self-inflicted, deliberate destruction of body tissue • No suicidal intent

Act of purposely harming one’s own body • • • •

Cutting Burning self Punching self/punching objects banging

Suicide not the goal; coping mechanism for emotional pain, anger, frustration

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FY2021 New Diagnosis Codes: Chapter 18 Deleted: R63.3 Feeding difficulties New Codes ▪ R63.30 Feeding difficulties, unspecified ▪ R63.31 Pediatric feeding disorder, acute ▪ R63.32 Pediatric feeding disorder, chronic ▪ R63.39 Other feeding difficulties • Includes – Feeding problem (elderly)(infant) NOS – Picky eater New Code ▪ R79.83 Abnormal findings of blood amino-acid level • Includes Homocysteinemia

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FY2021 New Diagnosis Codes: Chapter 19 Traumatic Brain Compression

Without herniation • S06.A0XA Traumatic brain compression without herniation, initial encounter • S06.A0XD Traumatic brain compression without herniation, subsequent encounter • S06.A0XS Traumatic brain compression without herniation, sequela

With herniation https://www.babydirectory.com/health_clinic/3_-_5yrs/first_aid/300/head_injuries

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• S06.A1XA Traumatic brain compression with herniation, initial encounter • S06.A1XD Traumatic brain compression with herniation, subsequent encounter • S06.A1XS Traumatic brain compression with herniation, sequela © 2021 Panacea Healthcare Solutions, Inc.

FY2021 New Diagnosis Codes: Chapter 19 Poisoning by Cannabis ▪ Poisoning by cannabis, accidental (unintentional) (T40.711A-T40.711S)

▪ Poisoning by cannabis, intentional self-harm (T40.712A-T40.712S) ▪ Poisoning by cannabis, assault (T40.713A-T40.713S) ▪ Poisoning by cannabis, undetermined (T40.714A-T40.714S) Adverse effect/Underdosing of Cannabis ▪ Adverse effect of cannabis (T40.715A-T40.715S) ▪ Underdosing of cannabis (T40.716A-T40.716S)

▪ Further specified by initial encounter/subsequent encounter/sequela

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FY2021 New Diagnosis Codes: Chapter 19 Poisoning by Cannabis Deleted Codes ▪ Poisoning by cannabis (derivatives), accidental (unintentional) (T40.7X1AT40.7X1S)

▪ Poisoning by cannabis (derivatives), intentional self-harm (T40.7X2A-T40.7X2S) ▪ Poisoning by cannabis (derivatives), assault (T40.7X3A-T40.7X3S) ▪ Poisoning by cannabis (derivatives), undetermined (T40.7X4A-T40.7X4S) Adverse effect/Underdosing of Synthetic Cannabis ▪ Adverse effect of cannabis (derivatives) (T40.7X5A-T40.7X5S) ▪ Underdosing of cannabis (derivatives) (T40.7X6A-T40.7X6S)

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FY2021 New Diagnosis Codes: Chapter 19 Poisoning by Synthetic Cannabis ▪ Poisoning by synthetic cannabinoids, accidental (unintentional) (T40.721A-T40.721S)

▪ Poisoning by synthetic cannabinoids, intentional self-harm (T40.722A-T40.722S) ▪ Poisoning by synthetic cannabinoids, assault (T40.723A-T40.723S) ▪ Poisoning by synthetic cannabinoids, undetermined (T40.724A-T40.724S) Adverse effect/Underdosing of Synthetic Cannabis ▪ Adverse effect of synthetic cannabinoids (T40.725A-T40.725S) ▪ Underdosing of synthetic cannabinoids (T40.726A-T40.726S)

▪ Further specified by initial encounter/subsequent encounter/sequela

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FY2022 New Diagnosis Codes: Chapter 19 Revised Code Titles (spelling error corrected) ▪ Toxic effect of contact with Portugese Man-o-war • T63.611A-T63.614S • Spelling corrected to “Portuguese”

▪ New Codes/Subcategory • T80.82XA Complication of immune effector cellular therapy, initial encounter • T80.82XD Complication of immune effector cellular therapy, subsequent encounter • T80.82XS Complication of immune effector cellular therapy, sequela

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FY2022 Diagnosis Codes: Chapter 22

New Code

U09.9 Post COVID-19 condition, unspecified • Code added by World Health Organization (WHO) • ICD-10-CM will implement this same code Some possible long-term effects following COVID-19 infection • Loss of smell or taste • Chronic respiratory failure • Pneumonia • Acute respiratory distress syndrome

Code First the specific condition related to COVID-19 if known

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Social Determinants of Health and Personal History Z Codes Additional Diagnosis Code Changes Social Determinants of Health added: ▪ Less than high school diploma ▪ Inadequate drinking water supply ▪ Homelessness unspecified/sheltered homelessness ▪ Lack of adequate food and safe drinking water ▪ Housing instability Personal History Codes added: ▪ Suicidal behavior ▪ Non-suicidal self-harm ▪ Immunosuppression therapy ▪ Chimeric Antigen Receptor T-cell therapy

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Social Determinants of Health and Personal History Z-Codes ▪ Immunization Counseling ▪ New Code Added

Z71.85 Encounter for immunization safety counseling • Includes: Encounter for vaccine product safety counseling

Code also if applicable, encounter for immunization (Z23) Code also if applicable, immunization not carried out (Z28.-)

Excludes 1: encounter for health counseling related to travel (Z71.84)

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FY2022 ICD-10-PCS Revisions, Additions,

Deletions: Guidelines

PCS Guideline Changes Format ▪ Guideline narrative additions appear in bold text ▪ Items underlined were moved within the guidelines since October 1, 2021. ▪ Deletions are shown as strikeouts The complete guidelines may be downloaded from https://www.cms.gov/files/document/2022-official-icd-10-pcs-coding-guidelines.pdf

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Guideline B3.7 Revised B3.7 Control vs. more definitive more specific root operations The root operation Control is defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.” If an attempt to stop postprocedural or other acute bleeding is unsuccessful, and to stop the bleeding requires performing a more definitive Control is the root operation coded when the procedure performed to achieve hemostasis, beyond what would be considered integral to a procedure, utilizes techniques (e.g. cautery, application of substances or pressure, suturing or ligation or clipping of bleeding points at the site) that are not described by a more specific root operation definition, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection. If a more specific root operation definition applies to the procedure performed, then the more specific root operation is coded instead of Control.

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Guideline B3.7 Examples Revised ▪ Example: Silver nitrate cautery to treat acute nasal bleeding is coded to the root operation Control. ▪ Example: Liquid embolization of the right internal iliac artery to treat acute hematoma by stopping blood flow is coded to the root operation Occlusion. ▪ Example: Suctioning of residual blood to achieve hemostasis during a transbronchial cryobiopsy is considered integral to the cryobiopsy procedure and is not coded separately. ▪ Example: Resection of spleen to stop bleeding is coded to Resection instead of Control

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Guideline B4.1c Revised B4.1c If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the furthest anatomical site from the point of entry anatomically most proximal (closest to the heart) portion of the tubular body part. Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part. A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the external iliac artery is also coded to the external iliac artery body part.

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Guideline B4.8 Revised B4.8 In the Gastrointestinal body system, the general body part values Upper Intestinal Tract and Lower Intestinal Tract are provided as an option for the root operations such as Change, Insertion, Inspection, Removal and Revision. Upper Intestinal Tract includes the portion of the gastrointestinal tract from the esophagus down to and including the duodenum, and Lower Intestinal Tract includes the portion of the gastrointestinal tract from the jejunum down to and including the rectum and anus. Example: In the root operation Change table, change of a device in the jejunum is coded using the body part Lower Intestinal Tract.

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New Technology Guideline Revised E. New Technology Section General Guidelines E1.a Section X codes fully represent the specific procedure described in the code title, and do not require additional codes from other sections of ICD-10-PCS. When section X contains a code title which fully describes a specific new technology procedure, and it is the only procedure performed, only the section X code is reported for the procedure. There is no need to report an additional code in another section of ICD-10-PCS. Example: XW04321 Introduction of Ceftazidime Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1 Example: XW043A6 Introduction of Cefiderocol Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 6, can be coded to indicate that Cefiderocol Anti-infective was administered via a central vein. A separate code from table 3E0 in the Administration section of ICD-10-PCS is not coded in addition to this code.

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New Technology Guideline Revised E. New Technology Section General Guidelines

E1.b ▪ When multiple procedures are performed, New Technology section X codes are coded following the multiple procedures guideline. ▪ Examples: Dual filter cerebral embolic filtration used during transcatheter aortic valve replacement (TAVR), X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2, is coded for the cerebral embolic filtration, along with an ICD-10-PCS code for the TAVR procedure. ▪ An extracorporeal flow reversal circuit for embolic neuroprotection placed during a transcarotid arterial revascularization procedure, a code from table X2A, Assistance of the Cardiovascular System is coded for the use of the extracorporeal flow reversal circuit, along with an ICD-10-PCS code for the transcarotid arterial revascularization procedure. ▪ Magnetically controlled growth rod (MCGR) placed during a spinal fusion procedure, a code from table XNS, Reposition of the Bones is coded for the MCGR, along with an ICD-10-PCS code for the spinal fusion procedure.

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Code Changes ICD-10-PCS 2022 Update

Overview of PCS Changes

▪ 191 new codes ▪ 107 deleted codes ▪ 62 revised codes ▪ Total ICD-10-PCS codes: • 78,220

Find the tables and index here: https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs

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Extraction – Central Nervous System and Cranial Nerves

Body Parts Added: Brain Cerebral Hemisphere

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Extirpation – Coronary Arteries ▪ New Qualifier Added ▪ Extirpation of coronary artery, Orbital Atherectomy Technique

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Orbital Atherectomy of Coronary Artery ▪ Effective to ablate severe calcified lesions ▪ Allows adequate stent expansion ▪ Helps optimize results of PCI in complex lesions

https://www.scirp.org/journal/paperinformation.aspx?paperid=92106

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Orbital Atherectomy of Coronary Artery ▪ Currently New Technology, Group 1: Deleted for 2022

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Fragmentation – Coronary Artery ▪ Body Part Added: Coronary Artery

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Fragmentation – Intracranial Artery ▪ Body Part Added: Intracranial Artery

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Replacement Heart

New Body Part: Heart New Devices: Biologic with Synthetic Substitute, autoregulated electrohydraulic Synthetic Substitute, Pneumatic

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Total Artificial Heart ▪ Autoregulated Electrohydraulic • Carmat TAH

▪ 2 Electrohydraulic pumps with pressure sensors and electronics ▪ Biologic valves placed at inlets/outlets of ventricles ▪ Designed to mimic natural heart shape ▪ Intended for full cardiac support in adults • Long-term alternative to transplant https://www.semanticscholar.org/paper/The-CARMAT-total-artificial-heart.-MohacsiLeprince/aa813251d5318ef22a26eeb521c32f23b75ca04f

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Total Artificial Heart ▪ Pneumatic TAH • SynCardia ▪ Pulsatile, two ventricles and four valves • Biocompatible plastic ▪ End stage biventricular heart failure ▪ Temporary bridge to transplantation • Patients at risk of imminent death –Cardiac transplant-eligible patients https://syncardia.com/patients/patient-resources/how-does-the-total-artificial-heart-work/

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Restriction – Left Ventricle

Body Part Added: Left Ventricle

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AccuCinch ▪ Treatment for heart failure ▪ Avoid open heart surgery ▪ Immediately reduces size of the heart • Heart pumps more efficiently

▪ Intended to repair left ventricle • Reduces heart failure symptoms • Improves quality of life

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Transcatheter Replacement – Pulmonary Valve ▪ Pulmonary valve replacement is traditionally an open procedure. ▪ Transcatheter option now available. ▪ Native Valve Replacement: Skirts on either side to seat the valve in place. Loaded onto a catheter via funnel and delivered to the native valve ▪ Conduit Valve Replacement: Early intervention that assumes the function of the pulmonary valve.

Harmony Valve (native)

Melody Valve (conduit)

https://www.accessdata.fda.gov/cdrh_docs/pdf20/P200046C.pdf https://www.medgadget.com/2012/10/medtronics-transcatheter-pulmonary-heart-valveused-for-mitral-valve-replacement-in-infants.html

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Transcatheter Replacement of Pulmonary Valve ▪ Qualifiers added: In Existing Conduit/Native Site

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Definitions Updates Body Part Key

Body Part Key Update ▪ Retropharyngeal space use Neck ▪ Parapharyngeal space use Neck

▪ Tibial sesamoid • use Metatarsal, Right • use Metatarsal, Left

▪ Fibular sesamoid • use Metatarsal, Right • use Metatarsal, Left

▪ Dorsal root ganglion • • • •

use Spinal Cord use Cervical Spinal Cord use Thoracic Spinal Cord use Lumbar Spinal Cord

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MS-DRG Changes

FY 2022 MS-DRG Classification Changes ▪ Large number of changes for 2022 ▪ CMS maintaining current structure of the 32 DRGs with a 3-way split • Delayed until 2023 or beyond

▪ Extensive to Non-Extensive OR Procedure Changes Moved FROM MS-DRGs 981, 982, 983

Moved TO 987, 988, 989

(Extensive OR Procedure Unrelated to Principal Diagnosis with MCC, with CC, without CC/MCC)

(Non-Extensive Procedure Unrelated to Principal Diagnosis with MCC, with CC, without CC/MCC)

3 Excision of subcutaneous tissue from chest, back and abdomen codes

31 Laser interstitial thermal therapy codes

3 Repair of esophagus via percutaneous, natural or artificial opening and natural or artificial opening endoscopic approach codes

1 Drainage of urethra code

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FY 2022 MS-DRG Classification Changes

Additional OR to Non-OR Changes

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▪ Additional OR to Non-OR Procedures for FY 2022 • 22 Open drainage of subcutaneous tissue and fascia procedure codes • Insertion of feeding device into stomach, open approach • Endoscopic extirpation of matter from the kidney, kidney pelvis, and ureter • Drainage of vestibular gland diagnostic, open or external approach

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FY 2022 MS-DRG Classification Changes

New CAR T-Cell, non-CAR T-cell and other immunotherapies assigned to MS-DRG 018

MS-DRG 018

MS-DRG 018 • Revised Title: Chimeric Antigen Receptor (CAR) t-CELL AND Other Immunotherapies

MS-DRG 233, 234

Coronary artery bypass procedures and Open Ablation procedure code reassigned to MS-DRGs 233, 234 • DRG Title revised to • Coronary Bypass with Cardiac Catheterization or Open Ablation with and without MCC

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FY 2022 MS-DRG Classification Corrections

Right Knee Joint Procedures

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▪ Right Knee Joint Procedures inadvertently omitted from grouper logic added • To MS-DRG 461, 462 – Bilateral or Multiple Major joint Procedures of lower Extremity with and without MCC • To MS-DRG 466, 467, 468 – Revision of Hip or Knee Replacement with MCC, with CC, and without CC/MCC • To MS-DRG 628, 629, 630 – Other Endocrine, Nutritional and Metabolic O.R. Procedures with MCC, with CC, and without CC/MCC – 11 additional procedure codes involving procedures on the right knee joint were also added here

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CC/MCC Designations FY 2022 CHANGES

CC/MCC Designation Overview ▪ CC/MCC Status Changes: CMS still considering major CC/MCC changes Code Designation MCC CC

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FY2022 Additions

FY2022 Deletions

Net Changes

+10

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MCC List Deletions ▪ G92 Toxic encephalopathy ▪ M31.1 Thrombotic microangiopathy

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MCC List Additions G04.82 Acute flaccid myelitis

Major Comorbid Conditions

G92.8

Other toxic encephalopathy

G92.9

Unspecified toxic encephalopathy

J12.82 Pneumonia due to coronavirus disease 2019 M31.10 Thrombotic microangiopathy, unspecified M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA] M31.19 Other thrombotic microangiopathy S06.A0XA Traumatic brain compression without herniation, initial encounter S06.A1XA Traumatic brain compression with herniation, initial encounter

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CC List Deletions ▪ M35.8 Other specified systemic involvement of connective tissue

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CC List Additions A79.82 Anaplasmosis [A. phagocytophilum] C56.3

Malignant neoplasm of bilateral ovaries

C79.63 Secondary malignant neoplasm of bilateral ovaries

Comorbid Conditions

C84.7A Anaplastic large cell lymphoma, ALK-negative, breast G92.03 Immune effector cell-associated neurotoxicity syndrome, grade 3 G92.04 Immune effector cell-associated neurotoxicity syndrome, grade 4 G92.05 Immune effector cell-associated neurotoxicity syndrome, grade 5 I5A

Non-ischemic myocardial injury (non-traumatic)

M35.07 Sjogren syndrome with central nervous system involvement M35.81 Multisystem inflammatory syndrome(22) M35.89 Other specified systemic involvement of connective tissue(22) Software. Consulting. Education. Results.

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Other FY2022 Changes ▪ Medicare Code Edit updates ▪ More DRG Grouping changes • Titles revised • DRGs revised • Codes grouping to different DRGs Find all the details at: https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page

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Leverage Technology CC/MCC CAPTURE, RISKS AND OPPORTUNITIES

CC/MCC Capture Report Example: Peer #1 Benchmark

Date: Client: University of ******** Report: CC/MCC Peer Specific Benchmarks Compared to: Peer #1 University Medical Center

DRG _ G RO UP

CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD CATH

DRG _ CO DE

TOTAL

LEGEND

DRG Ra te

Disc ha rge s

$37,410

Hospita l: P e e r Be nc hma rk: % - To% - To- Tota l Tota l

100%

V a ria nc e From Be nc hma rk

Adjuste d Disc ha rg es

Revenue and Data Integrity Opportunity Audit and Data Integrity Risk

Curre nt Re imb

$1,875,343

Adjuste d Re imb

$1,586,435

O pportunity / Risk

% Current Below/+Abo ve Expected Reimbursem ent

($ 2 8 8 , 9 0 8 )

17% 2 19 - CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD$ 4CATH 4 , 6 5 1W MCC

10 0 %

53%

48%

$ 1, 8 7 5 , 3 4 3

$984,555

($ 8 9 0 , 7 8 8 )

2 2 0 - CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD $ 3CATH 0 , 16 9 W CC

48%

- 48%

$ 6 0 1, 8 8 0

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CC/MCC Capture Report Example: Peer #2 Benchmark

Date: Client: University of ********** Report: CC/MCC Peer Specific Benchmarks Compared to: Peer #2 University Hospital

DRG _ G RO UP

DRG _ CO DE

TOTAL CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD CATH

LEGEND

DRG Ra te

$37,410

2 2 1 - CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD CATH W/ O CC/ MCC

Disc ha rge s

Hospita l: % - ToTota l

P EER # 2 Be nc hma rk: % - To- Tota l

V a ria nc e From Be nc hma rk

Adjuste d Disc ha rg es

Revenue and Data Integrity Opportunity Audit and Data Integrity Risk

Curre nt Re imb

100%

$1,875,343

- 8%

2 19 - CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD CATH W MCC

$44,651

10 0 %

47%

53%

$ 1, 8 7 5 , 3 4 3

2 2 0 - CARDIAC V ALV E & OTH MAJ CARDIOTHORACIC P ROC W/ O CARD CATH W CC

$ 3 0 , 16 9

45%

- 45%

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Adjuste d Re imb

O pportunit y / Risk

$1,451,700 ($ 4 2 3 , 6 4 3 ) $0

% Current Below/+ Above Expected Reimbur sement

29%

$ 8 8 2 , 5 14 ($ 9 9 2 , 8 2 8 ) $ 5 6 9 , 18 5

$ 5 6 9 , 18 5

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CLAIMSauditor Rule Example

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CLAIMSauditor Rule Example

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CC/MCC Pre-COVID and COVID Period Trend Report for Focused Audits & Education Complimentary Report ▪ As an attendee, you will receive a complimentary hospital CC/MCC and CMI trend report ▪ Up to 1 hour consultation to understand your specific top 5 DRG Categories for Opportunity/Risk and to understand your pre and post COVID impact

Optional Add-on Reports & Solutions ▪ Using the national database from our study we can provide custom peer group CC/MCC ratios, or by State, Region, Bed Size, Teaching/nonTeaching Status ▪ Your hospital’s CC/MCC and CMI Trend report by DRG category over 2 years ▪ MCC/CC capture rate by DRG category & DRG with financial impacts using national, state, and/or custom peer comparisons ▪ Partner with Panacea on focused audits and education with Panacea’s top tier consultants and robust coding compliance and lost revenue recovery solutions.

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Q&A

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THANK YOU! Panacea Healthcare Solutions Office: (866)-926-5933 contact@panaceainc.com

www.panaceainc.com

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References ▪ Centers for Medicare and Medicaid Services. (2020). 2022 ICD-10-CM. ▪ Centers for Medicare and Medicaid Services. (2020). 2022 ICD-10-PCS. ▪ Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates, (August 13, 2021). https://www.cms.gov/medicare/acute-inpatient-pps/fy-2022-ipps-final-rule-home-page ▪ US National Library of Medicine, National Institutes of Health, Diagnosis and Management of Gastric Intestinal Metaplasia: Current Status and Future Directions, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860040/

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