FY 2012 Changes to the Hospital
By Kathy DeVault, RHIA, CCS, CCS-P
THE FINAL RULE for the FY 2012 Hospital Inpatient Prospective Payment System was released August 1, 2011. Changes in the rule went into effect with October 1, 2011, inpatient discharges. MS-DRG Documentation and Coding Adjustment The Centers for Medicare and Medicaid Services (CMS) final- ized its proposed documentation and coding adjustment at 2 percent. The adjustment is a decrease from CMS’s initial pro- posal of 3. 15 percent and FY 2011’s 2. 9 percent. It represents $1.2 billion more in hospital payments in FY 2012 than allotted in the proposed rule. CMS finalized the documentation and coding adjustment to
eliminate what it claims is the effect of coding or classification
changes that do not reflect real changes in case mix. CMS will
continue its current methodology of calculating the documentation and coding adjustment and assessing hospitals until it
has recouped what it believes it has overpaid.
CMS deleted MS-DRG 015, Autologous Bone Marrow Transplant, and created MS-DRG 016, Autologous Bone Marrow
Transplant with CC/MCC, and MS-DRG 017, Autologous Bone
Marrow Transplant without CC/MCC.
Two procedure codes are needed to correctly identify the
rechargeable dual array deep brain stimulation system: codes
02.93 and 86.98. These cases are assigned to MS-DRGs 023, Craniotomy with Major Device Implant/Acute Complex CNS PDX
with MCC or Chemo Implant, and 024 Craniotomy with Major
Device Implant/Acute Complex CNS PDX without MCC. These
MS-DRGs are assigned for those implants not specified as rechargeable.
Procedure codes 38. 45, Resection of vessel with replacement,
thoracic vessel, and 39. 73, Endovascular implantation of graft
in thoracic aorta, were removed from MS-DRGs 237 and 238.
These procedures were added to MS-DRGs 216, 217, 218, 219,
220, and 221, all of which are cardiac valve MS-DRGs with and
without cardiac catheterization.
Three new MS-DRGs were added to identify excisional debridement procedures. The new MS-DRGs, based on procedure code 86.22, Excisional debridement of wound, infection,
or burn, will now be assigned to one of the following MS-DRGs:
Excisional debridement was previously assigned to MS-DRGs
573–578. These MS-DRGs will be maintained for skin graft procedures.