CMS will increase the applicable percent reduction, the portion of Medicare payments available to fund the value-based incentive payments under the program, to 1.5% of the base operating DRG payment amounts as mandated by the ACA.
"CMS continues to add financial incentives for patient outcomes, it's our job to make sure coded data correctly reflects the appropriate outcome," Wallace says.
CMS is proposing to create the following MS-DRGs for endovascular cardiac valve replacements:
Proposed new MS-DRG 266 (endovascular cardiac valve replacement with MCC)
Proposed new MS-DRG 267 (endovascular cardiac valve replacement without MCC)
"These patients are a different population since they are not amenable to traditional open valve replacement due to co-existing medical conditions presenting different peri-operative and postoperative morbidity," McCall says. "Although this is done in the cath lab, the patients are considered high risk."
CMS is also proposing to collapse MS-DRGs 483 (major joint/limb reattachment procedure of upper extremity with CC/MCC) and 484 (major joint/limb reattachment procedure of upper extremity without CC/MCC) into a single MS-DRG. CMS would delete MS-DRG 484 and revise the title of MS-DRG 483 to "major joint/limb reattachment procedure of upper extremities".