Top 10 MS-DRG Shifts
The CMS ICD-10 website contains information on the ICD-10 MS-DRG Conversion Project. An article, “Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments”, updated 2/25/13, lists the top 10 MS-DRGs that shift to another DRG when re-coded with ICD-10. Below are 4 of the 10 most significant MS-DRG changes:
- MS-DRG 812, Red Blood Cell Disorders without MCC
Sequencing Anemia as the principal diagnosis under ICD-9 groups these cases to MS-DRG 812. However, the ICD-10-CM guideline states to sequence the appropriate code for the malignancy as the principal or first-listed diagnosis followed by code D63.0, Anemia in Neoplastic Disease. Sequencing the malignancy first under ICD-10 usually will group these cases to a higher-weighted MS-DRG related to cancer.
- MS-DRG 391, Esophagitis, Gastroenteritis & Miscellaneous Digestive Disorders with MCC
Under ICD-9, Esophageal Hemorrhage has its own unique code, 530.82 and groups to MS-DRG 368 (with the addition of an MCC). Also, ICD-9 code 530.89, Other Disorders of Esophagus, groups to MS-DRG 391 (with the addition of an MCC). Code 530.89, which is not an MCC, is the closest match to the ICD-10 code, K22.8, Other Diseases of Esophagus which includes esophageal hemorrhage in its definition and is the cause of about 90% of the weight change. A record without an MCC will shift to a lower-weighted MS-DRG.
- MS-DRG 885, Psychoses
ICD-9 cases that have code 296.20, Major Depression, Single Episode, Unspecified sequenced as the principal diagnosis groups to MS-DRG 885, Psychoses. Under ICD-10, this same diagnosis is assigned to F32.9, which includes Depression NOS. This will group the case to a lower-weighted MS-DRG 881, Depressive Neuroses.
- MS-DRG 191, Chronic Obstructive Pulmonary Disease with CC
Under ICD-9, code 491.21, Acute Exacerbation of COPD can be further specified to:
- COPD with Acute Bronchitis, 491.22
- COPD with Acute Exacerbation of Asthma, 493.22
Under ICD-9, all of these codes are listed as CCs. Cases will group to MS-DRG 191, Chronic Obstructive Pulmonary Disease with CC when either condition above is sequenced as the principal diagnosis followed by one of the other conditions listed above as a secondary diagnosis.
Under ICD-10, one code, J44.1, COPD with Acute Exacerbation includes chronic obstructive bronchitis, chronic obstructive asthma, and chronic obstructive pulmonary disease in its description. Therefore, the same scenario above will group to a lower-weighted MS-DRG 192, Chronic Obstructive Pulmonary Disease without CC/MCC in ICD-10 because these additional conditions will not be coded separately.