HIMagine That: Non-OR procedures

Aug. 22, 2016 / By Sue Belley, RHIA, Donna Smith, RHIA

Donna: Hi Sue. Have you had a chance to read through the FY 2017 Final Rule since our last chat?

Sue: I haven’t read all 2,434 pages if that’s what you mean, but I have taken a peek at some sections.  How about you?

Donna: Same here – working my way through it . . . I like to look at the MS-DRG Definitions Table.  Every year, CMS publishes updates to the table based on their evaluation of data from the previous year. I was particularly interested to note that they are reclassifying some surgical procedures from OR procedures to Non-OR procedures this year.

Sue: Is this a result of ICD-10?

Donna: I think so.  You know CMS analyzes MS-DRG data yearly to determine if any changes need to be made to the system, as well as considering public commentary, right?

Sue: Yes…

Donna: And, CMS has said all along that the ICD-10 version of MS-DRGs should replicate the ICD-9 version of MS-DRGs, so I believe they did some tweaking to fix a few things that weren’t quite right, such as procedures that were classified as Non-OR procedures in ICD-9 but classified as OR procedures in ICD-10. In some cases, the result was surgical DRGs instead of medical DRGs.

Sue: This did cause some havoc!  A really good example is the ICD-10-PCS code for arterial monitoring which was classified as an OR procedure in the ICD-10 version of MS-DRGs when the code for arterial monitoring in ICD-9 was a Non-OR procedure.  I saw the PCS code for this will be reclassified to a Non-OR procedure effective October 1, 2017.

Donna: I’m certainly happy about that one. The fact that it was classified as an OR procedure for FY 2016 caused a whole lot of angst in the hospital coding community.

Sue: I know – a lot of coders talked to me about it.

Donna: There was also a lot of discussion about the PCS code for arterial catheterization because its assignment resulted in a surgical DRG in many cases and coders knew that hadn’t been the case with the ICD-9 code. I had many clients ask about the appropriateness of using this PCS code because of the DRG shift it was causing. 

Sue: And the 2nd Quarter, 2016, Coding Clinic* even addressed it – it was an interesting Q&A.

Donna: Agreed!  I think that hospitals who opted not to code the insertion of arterial catheters because of the resultant DRG shift will now be comfortable with their decision to do so since  CMS is taking  this step to make sure that there is replication of the ICD-10 MS-DRGs in this regard.

Sue: I also noted in the FY 2017 Final Rule that CMS stated they will continue to work with AHA Coding Clinic to promote proper coding.

Donna: I saw that, too. The AHA Coding Clinic can help standardize coding to ensure data consistency.

Sue:  One last example of an OR Procedure that was causing MS-DRG shifts: the PCS code for removal of infusion devices such as central lines. These codes, 02PY33Z, are now included in Table 6P.4e as being moved from OR to NON-Or status.

Donna: Yes, that was another one causing concern in the coding community because it was causing a DRG shift in some cases when grouped in ICD-10, which was not the case in ICD-9. . . but let’s leave this for discussion on another day!

Sue: Ok – we’ll keep in touch!

Sue Belley, RHIA, Donna Smith, RHIA, are with the consulting services business of 3M Health Information Systems.

*AHA Coding Clinic, 2nd Quarter, 2016, page 32, http://www.ahacentraloffice.org/codes/products.shtml#CodingClinic