FY 2021 IPPS Proposed Rule: MSDRG Changes

The 2021 Inpatient Prospective Payment Systems (IPPS) proposed rule is out and as data nerds, we could not wait to dig into it and see what changed. A comparison of Table 5 – listing of MS-DRGs and relative weights – is a great place to start.

Quick refresher on terms:

  • Medicare Severity-Diagnosis Related Group (MS-DRG) is a classification system for inpatient discharges that helps standardize payment of services.
  • Relative Weight (RW) reflects the patient’s severity of illness and is a measure of costliness or average resources required to care for cases assigned to that MS-DRG. A higher RW yields a higher payment.

What are the new and deleted codes for FY 2021 (MSDRG V38)?

Six (6) MSDRGs are removed for FY 2021 and twelve (12) MSDRGs have been created.

How are relative weights changing from FY 2020 to FY 2021?

The vast majority (80.9%) of MS-DRG relative weights are experiencing an increase or decrease of less than 5%. How payment is affected by the change in relative weights at your facility depends on your specific mix of services and volumes.

What’s Happening with Bone Marrow Transplants?

We do not typically see a change in the “Type” category but noticed the switch from surgical to medical for the three bone marrow transplant procedures. CMS received the request to make the change because bone marrow transplant procedures involve transfusion services that do not require the resources of the operating room. CMS also identified eight (8) ICD-10 procedure codes associated with bone marrow transplants that are currently designated as operating room procedures. For clinical consistency, they are proposing to reassign these codes as non-operating room.

Want to make a comment to CMS on MSDRG Classification concerns?

The deadline to request updates to the MS-DRGs is now October 20th of each year – almost two weeks earlier than in previous years. For FY 2021, interested parties needed to submit comments and suggestions by November 1, 2019. CMS encourages comments and suggestions for FY 2022 by October 20, 2021 via the CMS MS-DRG Classification Change Request Mailbox located at: MSDRGClassificationChange@cms.hhs.gov

CMS’s Acute Care Hospital Inpatient Prospective Payment System FACT SHEET: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2021-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute

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