ICD-10 MS-DRGs Version 38.1 Effective January 1, 2021
Posted on: 12/1/2020
In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective January 1, 2021. In addition, the Centers for Medicare & Medicaid Services (CMS) is implementing 21 new procedure codes to describe the introduction or infusion of therapeutics, including monoclonal antibodies and vaccines for COVID-19 treatment, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), also effective January 01, 2021.
Acute Hospital Care at Home
In March 2020, CMS announced the Hospitals Without Walls program, which provides broad regulatory flexibility that allowed hospitals to provide services in locations beyond their existing walls. CMS is expanding on this effort by executing an innovative Acute Hospital Care At Home program, providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes.
To support these efforts, CMS has launched an online portal to streamline the waiver request process and allow hospitals and healthcare systems to submit the necessary information to ensure they meet the program’s criteria to participate. CMS will also closely monitor the program to safeguard beneficiaries by requiring hospitals to report quality and safety data to CMS on a frequency that is based on their prior experience with the Hospital At Home model.
Amublatory Surgical Center Flexibility
As part of Hospital Without Walls, CMS also previously announced regulatory flexibility that allowed ASCs – facilities that normally provide same-day surgical care – the ability to be temporarily certified as hospitals and provide inpatient care for longer periods than normally allowed, with the appropriate staffing in place. ASCs are normally subject to a requirement that patients only remain in their care for less than 24 hours or require admission to a regular hospital.
Last week, CMS announced an update to that regulatory flexibility, clarifying that participating ASCs need only provide 24-hour nursing services when there is actually one or more patient receiving care onsite. The program change provides ASCs enrolled as hospitals the ability to flex up their staffing when needed and provide an important relief valve in communities experiencing hospital capacity constraints, while not mandating nurses be present when no patients are in the ASC. The flexibility is available to any of the 5732 ASCs throughout the country seeking to participate and will be immediately effective for the 85 ASCs currently participating in the Hospital Without Walls initiative. CMS expects this flexibility will allow these and additional ASCs enrolled as hospitals to serve as an added access point that will allow communities to maintain surgical capacity and other life-saving non-COVID-19, like cancer surgeries. Allowing these types of treatments to occur in designated ASCs enrolled as hospitals while hospitals are managing any surges of COVID-19 would allow vulnerable patients to receive this needed care in settings without known COVID-19 cases.
ViewtThe ICD-10 MS-DRG V38.1 Grouper Software, Definitions Manual Table of Contents, and the Definitions of Medicare Code Edits V38.1 manual to accommodate these new diagnosis and procedure codes, effective for discharges on or after January 01, 2021 >>>
Index and Tabular Addenda for the new diagnosis codes >>>
The Centers for Medicare and Medicaid Services and the ACMA Public Policy Committee contributed to this information.
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