The Centers for Medicare and Medicaid Services (CMS) recently announced the release of the proposed Inpatient Prospective Payment System (IPPS) rule for fiscal year 2023, which includes updates to the ICD-10-CM and ICD-10-PCS code sets. In this guide, we will discuss the new ICD-10 codes for FY2023 and the proposed IPPS rule.
ICD-10-CM Updates:
The proposed FY2023 IPPS rule includes 753 new ICD-10-CM codes, as well as several revisions and deletions. Some of the notable changes include:
- COVID-19: The proposed rule includes new codes to identify the specific COVID-19 vaccine and to indicate if the vaccine was administered as part of a clinical trial. Additionally, there are new codes for “long COVID,” which is a condition where individuals continue to experience symptoms of COVID-19 for an extended period of time.
- Mental Health: The proposed rule includes new codes for substance use disorders, including new codes for synthetic cannabinoid-related disorders and other specified substance use disorders. There are also new codes for mental health conditions, such as major depressive disorder with mixed features and bipolar disorder in remission.
- Diabetes: The proposed rule includes new codes for diabetic retinopathy with macular edema, as well as codes for diabetes with chronic kidney disease and diabetic polyneuropathy.
ICD-10-PCS Updates:
The proposed FY2023 IPPS rule also includes updates to the ICD-10-PCS code set, including 329 new codes and several revisions and deletions. Some of the notable changes include:
- COVID-19: The proposed rule includes new codes for the administration of COVID-19 vaccines and monoclonal antibodies, as well as new codes for procedures related to COVID-19, such as extracorporeal membrane oxygenation (ECMO) for respiratory failure due to COVID-19.
- Transplants: The proposed rule includes new codes for heart and lung transplants, as well as codes for the removal of donor organs for transplantation.
- Mental Health: The proposed rule includes new codes for electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for the treatment of mental health conditions.
Proposed IPPS Rule:
In addition to the updates to the ICD-10 code sets, the proposed IPPS rule includes several changes to the hospital inpatient prospective payment system. Some of the notable changes include:
- Payment Rates: The proposed rule includes a 2.3% increase in payment rates for acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program.
- Quality Reporting: The proposed rule includes changes to the Hospital IQR Program, including the removal of several measures related to patient experience and the addition of several new measures related to opioid use and patient safety.
- COVID-19: The proposed rule includes changes to the Medicare Severity Diagnosis Related Group (MS-DRG) for COVID-19 cases, including the removal of the “unrelated COVID-19 diagnosis” designation and the addition of new MS-DRGs for cases with and without ventilator support.
Conclusion:
The new ICD-10 codes for FY2023 and the proposed IPPS rule reflect the ongoing changes in the healthcare industry, including the ongoing impact of the COVID-19 pandemic and the focus on mental health and substance use disorders. Accurate coding and billing are essential for hospitals and healthcare providers, and understanding the updates to the ICD-10 code sets and the proposed IPPS rule is crucial for proper reimbursement and compliance.