2015 IPPS Proposed Rules Detailed

Michelle A. Leppert, CPC , May 1, 2014

CMS is also proposing to delete MS-DRG 490 and 491 and replaced them with the following MS-DRGs:

  • Proposed new MS-DRG 518 (back & neck procedures except spinal fusion with MCC or disc device/neurostimulator)
  • Proposed new MS-DRG 519 (back & neck procedures except spinal fusion with CC)
  • Proposed new MS-DRG 520 (back & neck procedures except spinal fusion without CC/MCC)

CMS also proposes removing the following additional diagnosis codes to MS-DRG 794 (neonate with significant problems):

  • V17.0, family history of psychiatric condition
  • V17.2, family history of other neurological diseases
  • V17.49, family history of other cardiovascular diseases
  • V18.0, family history of diabetes mellitus
  • V18.19, family history of other endocrine and metabolic diseases
  • V18.8, family history of infectious and parasitic diseases
  • V50.3, ear piercing

"These diagnoses really don't impact the newborn but cause a normal newborn DRG 795 to move to the higher paying DRG 794 when assigned as an additional diagnosis," McCall says.

Additional changes

CMS also proposes changes to the Hospital Inpatient Quality Reporting Program.

The proposed rule would increase IPPS operating payment rates by 1.3% after reductions, including a 0.8% coding and documentation reduction. CMS estimates Medicare payments to inpatient facilities will decrease by $241 million in Fiscal Year 2015.

A display copy of the proposed rule is available on the Federal Register website.

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