Healthcare still figuring out how ICD-10 coding has shifted DRGs

Carl Natale
by Carl Natale
Healthcare still figuring out how ICD-10 coding has shifted DRGs

When theCenters for Medicare and Medicaid Services (CMS) recast the Medicare Severity-Diagnosis Related Groups (MS-DRGs) for ICD-10 codes, it did so to make them revenue neutral.

Meaning that while some ICD-10 DRGs created more revenue and some created less revenue, the net effect would be a wash.

Sometimes reality doesn't match design. And that seems to be what the Advisory Board is outlining in a recent post on MS-DRG volatility. They report that  there seem to be some major shifts and that CMS is investigating some MS-DRGs:

  • 020-027 - Intracranial Vascular Procedures
  • 466-468 - Revision Of Hip Or Knee Replacement
  • 515-517 - Other Musculoskelet Sys & Conn Tiss O.R. Proc
  • 945-946 — Rehabilitation

It's important to note that the Advisory Board attaches a caveat to its report. That they don't have enough "ICD-10 claims data currently publicly available." Which is really interesting since one of the reasons U.S. healthcare was implementing ICD-10 coding was to access granular ICD-10 data.

After 13 months of ICD-10 coding, we still don't have enough data to understand fully how the ICD-10 transition has affected healthcare. But CMS is still studying and making adjustments.

Healthcare providers are going to have look at their own data and try to identify problems. 

Then they can reach out to healthcare payers and CMS to find out if there are solutions. Hopefully enough feedback will lead to reviews such as the ones referenced by Advisory Board.

It might also help to reach out to specialty societies or organizations to see if membership has any solutions or lobbying efforts to correct the problem.

The only constant in healthcare is change. Mandates and innovation will constantly change how healthcare providers practice medicine and charge for it. They're going to need to measure those changes to understand the change and preserve business.