Knowledge Base Article

For the CMS FY 2024, CMS has proposed several changes to the Major Diagnostic Category (MDC) 05: Diseases and Disorders of the Circulatory System. This article focuses on these proposed changes. You can read about proposed changes in other MDCs in a related article in this week’s newsletter.

Surgical Ablation

A request was made for CMS to review the MS-DRG assignment of cases involving open concomitant surgical ablation procedures, recommending that open concomitant surgical ablation procedures for atrial fibrillation (AF) be reassigned from MS-DRGs 219, 220, and 221 (Cardiac Valve and Other Major Cardiothoracic Procedures without Cardiac Catheterization with MCC, with CC, and without CC/MCC, respectively) to MS-DRGs 216, 217, and 218 or create new MS-DRGs for all open mitral or aortic valve repair or replacement procedures with concomitant surgical ablation of AF.

CMS analysis found these cases require greater resources, have higher average costs and generally longer lengths of stay compared to all other cases in their assigned MS-DRG. CMS is proposing to create new base MS-DRG 212 (Concomitant Aortic and Mitral Valve Procedures) for cases reporting an aortic valve repair or replacement procedure, a mitral valve repair or replacement procedure, and another concomitant procedure in MDC 05.

External Heart Assist Device

Currently, the three ICD-10-PCS procedure codes describing the insertion of a short-term heart assist device are recognized as extensive O.R. procedures assigned to MS-DRG 215 (Other Respiratory O.R. Procedures with MCC, with CC, and without CC/MCC, respectively) in MDC-05. One of the codes is for an open approach (02HA0RZ: Insertion of short-term external heart assist system into heart, open approach). The other two codes describe a percutaneous approach.

CMS is proposing to reassign the open approach code when reported as a standalone procedure from MS-DRG 215 in MDC-05 to Pre-MDC MS-DRGs 001 and 002. Under this proposal, this code will no longer need to be reported as a part of a procedure code combination or procedure code “cluster” to satisfy the logic assigned to MS-DRGs 001 and 002.

Ultrasound Accelerated Thrombolysis for Deep Vein Thrombosis

A request was made to reassign cases reporting USAT of peripheral vascular structures procedures with the administration of thrombolytic(s) for deep venous thrombosis from MS-DRGs 252, 253, and 254 (Other Vascular Procedures with MCC, with CC, and without CC/MCC, respectively) to MS-DRGs 270, 271, and 272 (Other Major Cardiovascular Procedures with MCC, with CC, and without CC/MCC, respectively).

Although CMS found this subset of cases does not clinically align with patients undergoing surgery for acute myocardial infarction, the difference in resource consumption does warrant creating a new MS-DRG to reflect more appropriate payment for USAT and standard CDT procedures of peripheral vascular structures. CMS is proposing to create new MS-DRGs 278 and 279 (Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structures with MCC and without MCC, respectively).

Coronary Intravascular Lithotripsy

A request was made to review MS-DRG assignment of cases describing percutaneous intravascular lithotripsy (IVL) involving the insertion of drug eluting and non-drug eluting stents. According to the requestor, cases involving IVL are more complex as this is a therapy deployed exclusively in several calcified coronary lesions that are associated with longer procedure times and increased resources.

CMS analysis showed that cases reporting percutaneous coronary IVL, with or without a stent had higher average costs and lengths of stay. CMS is proposing to create two new MS-DRGs:

• MS-DRGs 323 and 324 (Coronary Intravascular Lithotripsy with Intraluminal Device with MCC and without MCC, respectively), and
• MS-DRGs 325 (Coronary Intravascular Lithotripsy without Intraluminal Device).

Eliminating Distinction Between Bare Metal and Drug Eluting Stent (DES)

CMS notes it appears to no longer be necessary to subdivide the MS-DRGs for percutaneous cardiovascular procedures based on the type of coronary intraluminal device inserted. Therefore, they are proposing to delete MS-DRGs 246, 247, 248, and 249, and are proposing new MS-DRG 321 (Percutaneous Cardiovascular Procedures with Intraluminal Device with MCC or 4+ Arteries/Intraluminal Devices) and MS-DRG 322 (Percutaneous Cardiovascular Procedures with Intraluminal Device without MCC).

CMS is also proposing to revise the titles for MS-DRGs 250 and 251 from “Percutaneous Cardiovascular without Coronary Artery Stent with MCC, and without MCC, respectively” to “Percutaneous Cardiovascular Procedures without Intraluminal Device with MCC, and without MCC, respectively” to better reflect the ICD-10-PCS terminology of “intraluminal devices” versus “stents” as used in the procedure code titles within the classification.

Cardiac Defibrillators and Shock

During a review of cardiogenic shock, CMS noted data analysis shows the average costs and length of stay are generally similar for cardiac defibrillator cases without regard to the presence of AMI, Heart Failure (HF), or shock. CMS is proposing to delete MS-DRGs 222, 223, 224, 225, 226, and 227, and create three new MS-DRGs:

• MS-DRG 275 (Cardiac Defibrillator Implant with Cardiac Catheterization and MCC, and
• MS-DRGs 276 and 277 (Cardiac Defibrillator Implant with MCC, and without MCC, respectively).

Specific to MS-DRG 275, CMS is proposing to designate procedure codes describing cardiac catheterization as non-O.R. procedures affecting the MS-DRG.

CMS is accepting comments through June 9, 2023.