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ICD-10 Won’t Significantly Impact MS-DRGs for Two Years

- It will be business as usual for MS-DRG assignment for at least another two years after the implementation of ICD-10, says an article published this month in the Journal of AHIMA, since new DRGs mapped to the increased specificity of the ICD-10 code set won’t be released until the industry has enough higher-level data to create them.  While some necessary changes in the new system will produce minor differences in payments, the ICD-10 MS-DRGs are basically “a replication” of those currently in use under ICD-9, writes a team of researchers from 3M Health Information Systems, and will have little impact on the Medicare Severity Diagnosis Related Groups used for inpatient reimbursement in the immediate future.

“Because the ICD-10 MS-DRGs replicate the ICD-9 MS-DRGs, they do not take advantage of the increased specificity of ICD-10,” the article says. “If the ICD-10 MS-DRGs had been optimized to take full advantage of ICD-10, they would have been inconsistent with the existing MS-DRG payment weights. Since there is no substantial database of records coded in ICD-10 available, there is no way of recalibrating the MS-DRG payment weights to correspond to ICD-10 optimized MSDRGs. Hence the MS-DRGs cannot take full advantage of ICD-10 until there is enough ICD- 10 data available to allow the recalculation of the MS-DRG payment weights.”

It will take two years for the industry to collect enough ICD-10 data to significantly retool MS-DRG assignment, and perhaps more time to release the updated reimbursement scheme.  Meanwhile, payment differences for hospitals will likely be less than one percent, and will generally even out.

“When the MS-DRGs are optimized to take advantage of the detail in ICD-10, there may be a substantial impact on payments,” the article warns, but hospitals that successfully submit valid claims with correct ICD-10 codes after the October 1, 2015 implementation ate should not anticipate significant payment disruptions from shifting MS-DRG assignments alone.

 

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