CMS Scales Back on Payment Cuts

Andrea Kraynak, for HealthLeaders Media , August 3, 2011
DRG adjustments

When it comes to the recalibration of relative weights for MS-DRGs, there are winners and losers every year, according to Kennedy.

Kennedy is pleased with the DRG for autologous bone marrow transplant was split according to their CC/MCC status. “They took the MS-DRG 15 and split it up into two parts, MS-DRG 16 (with CC/MCC) and MS-DRG 17 (without CC/MCC),” he explains. “Since CMS demonstrated that patients with CC/MCC require more resources that those without, this split better allocates CMS funding for this procedure.” 

Additionally, the final rule divides excisional debridement and skin grafting in skin conditions not involving endocrine, nutritional, or metabolic principal diagnoses. “We agree with the commenters that data support the creation of three new debridement MS-DRGs 570, 571, and 572 for skin debridement and the revision of MS-DRGs 573 through 578 to include skin grafts only,” CMS says in the final rule.

This is a good change and there’s good data analysis behind it, Kennedy says. And it provides for greater reimbursement for hospitals that do grafts, which is correct because they do take more resources, he adds.

CC/MCC updates

CMS included a few notable updates to the list of CCs and MCCs for FY 2012.

For example, there is a new code for pancytopenia due to chemotherapy (code 284.11) as well as pancytopenia due to other drugs (code 284.12).

“To everybody’s surprise, these codes were designated as MCCs. There was an expectation that drug-induced pancytopenia would lose its MCC status because pancytopenia due to chemo used to code to aplastic anemia, a MCC,” Kennedy says. “This happened when the CDC implemented a code for chemotherapy-induced anemia, which used to be coded to aplastic anemia; it lost its CC status altogether! So I’m elated. Hospitals—especially cancer and pediatric hospitals—should be very grateful for this.”

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