Behavioral Health Amid the Coding Crisis

Now's the time for the Talk 10 Tuesday Coding Report with our good friend Christine Geiger.

And good morning, Chris.

Good morning.

And speaking of that final rule, July is coming to an end.

So hopefully only a few more days until we get that final rule.

Gives us just enough time to take a look at a couple of the proposed DRG changes.

First one's going to be an MDC-5, Diseases and Disorders of the Circulatory System, and it's going to deal with cardiac pacemaker revisions and replacements.

Now, the proposals to lead five MS-DRGs related to these procedures, that would be MS-DRG 258, 259, 260, 261, and 262.

DRGs 258 and 259 are going to relate to cardiac pacemaker replacements.

with or without an MCC.

DRGs 260 through 262 are going to relate to those cardiac pacemaker revisions with a three-way severity split.

Now we know if something's proposed to be deleted, there has to be something to make a replacement for these cases.

So two new proposed combined MS-DRGs are going to take their place with a two-way severity split, MS-DRG 210 and 211.

Now, 210 will be cardiac pacemaker revision or device replacement with MCC, and MS-DRG-211 will be cardiac pacemaker revision or device replacements without MCC.

Now, it's been 43 years since DRGs for pacemaker revision and replacement procedures were created.

In the proposed rule, it notes that this change was based on analysis of claims data from FY25.

Shows that now the resource utilization appears to be aligned and the cases are now more clinically coherent, making the total restructuring of these DRGs appropriate.

As part of the restructuring, PCS code XHH80HB, insertion of ultrasound transmitter and battery for endocardiac pacing electrode in the chest, subcutaneous tissue, and fascia.

Open approach new technology group 11 is going to assign to new DRGs 211 and 212 when it's reported as a standalone procedure.

For our next DRG change, let's go ahead and stay in MDC 5.

There's a proposal to delete MS-DRG 264, which is other circulatory system OR procedures.

Again, we know if something's going to be deleted, there has to be something to take its place.

Two new MS-DRGs are proposed here, MS-DRG 361 and 362.

361 will be other circulatory system OR procedures with MCC, and DRG 362 will be other circulatory system OR procedures without that MCC.

In this case, a review of claims data supported the restructuring of the MS-DRGs with that two-way severity split, either with or without an MCC.