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The Future of ICD-10-CM/PCS has Arrived: Obtain Insight into the 2020 ICD-10 Code Sets

September 5, 2019

1 AAPC CEU and 1 AHIMA CEU will be awarded to all Webinar attendees who join the entire live web session. Certificates to obtain CEUs will be emailed within 3 business days upon completion of each Webinar.


Be ready by October 1, 2019, for the mandated code updates of hundreds of ICD-10 diagnosis and procedure codes.

During this complimentary, 60-minute educational session, Vitalware will provide a thorough discussion of the revised 2020 ICD-10-CM/PCS code sets.

Coding professionals should come away with a greater understanding of the updated ICD-10 diagnosis and procedure code sets, allowing for accurate and compliant coding that supports optimized reimbursement.

Attendees will leave the webinar being able to:

  • Apply the numerous coding updates.
  • Recognize potential documentation needs.
  • Identify potential MCC and CC changes.
  • Be proactive with the code changes, improving productivity and avoiding setbacks to reimbursement.

Change is a constant…wouldn't it be nice to expect a constant for a change?

Not that I like saying it, but “change CAN be good”… sometimes. Fortunately, healthcare facilities expand and grow in ways that meet our individual healthcare needs with new technology and promising treatments. This type of change is nothing short of a blessing for some. To meet these changes we have to change as a facility and as a consumer in many ways as well. The downside to these changes come with facilities vying for the constantly dwindling Medicare dollar and customers seeking affordable healthcare with rising costs. In an effort to stay ahead of the game and to compete for these funds facilities have to adapt each year to the CMS Final Rule. While we may not fully understand all of the implications or impacts of each year’s upcoming rule until a few months into the fiscal year, one thing is certain, funds are expected to reduce for most. This year, however, we might have just lucked out as most of the numerous proposed rule changes did not finalize. If you hadn’t looked at the proposed rule as of yet consider yourself one of the lucky ones. Most of the proposed changes would have affected facility payments through aggressive CC/MCC changes. It would appear that these considerations could have had a negative impact on facilities MS-DRGs being reported for the upcoming fiscal year and in the end were not put into effect.

Another good change comes to some of our smaller facilities. Rural or low wage hospitals are seeing a long-deserved bump in their wage index payment for 2020 and into the next four years. Only those hospitals that are below the 25th percentile will see this increase. However, this raise comes at a price for other hospitals. Those hospitals that are currently above the 75th percentile will be reduced, but not at a rate of more than 5 percent of their current 2019 wage index. This decision was said to be made in an effort to maintain Medicare’s current budget and to offset any increase. This is just one area of change mentioned in CMS’s Final Rule filed on August 2, 2019, in the Federal Register with many more changes being discussed.

For coders, the Final Rule is usually a hurdle to run and jump over the first few months in the fiscal year. By the time we catch onto all the changes, a new and upcoming rule is being proposed. This year may be a well-deserved break for most coding professionals. As a coding auditor, some of the proposed rule changes were baffling, to say the least. It would appear that most everyone agreed that the CC/MCC proposals did not make sense. Usually, in the past, most changes revolve around CC/MCC reporting, but for this year most of the differences revolve around new codes, revised codes, and deleted codes. Below is a few examples of the CC/MCC proposals that DID NOT GET FINALIZED in regards to CM codes:

  • Removing E43. Unspecified severe protein-calorie malnutrition from an MCC to a CC (generally most providers only use this verbiage of unspecified severe protein-calorie malnutrition). Education would have been needed in an effort to avoid this reduction.
  • Moving E44.0 Moderate protein-calorie malnutrition from CC to MCC (not an easy task to get some providers to clarify malnutrition to this extent).
  • Moving R78.81 Bacteremia from CC to MCC
  • OB changes with complications added as MCCs
  • Pressure ulcer codes made CCs (while some would have decreased from an MCC to a CC this change would have affected more codes being made a CC that was previously not).

The good news just keeps coming with the actual number of changes finalized to the CC/MCC list as being relatively small:

  • # of deleted CCs = 5
  • # of deleted MCCs = 0
  • # of added CCs = 75
  • # of added MCCs = 5

There is still plenty of changes to review for this upcoming fiscal year. Below is a few examples of proposed changes that DID GET FINALIZED and that have an effect on MS-DRGs 034-039 with PCS code classification relationships:

  • Removal of procedure codes from MS-DRGs 034, 035, and 036 that do not utilize an intraluminal device that is not performed on a carotid artery but other arteries, and/or that was performed on a vein.
  • Removal of procedure codes describing dilation of a carotid artery with an intraluminal device from MS-DRGs 037, 038 and 039
  • Reassign the carotid dilation procedure codes from MS-DRGs 037, 038, and 039 to MS-DRGs 034, 035, and 036

For 2020, the CM code set after deletions and additions gained overall 252 codes for a total of 72,184 codes which is up from 71,932 in 2019. For the PCS code set after deletions and additions lost 1,322 codes for an overall total of 77,559 in 2020 which is a reduction from 78,881 in 2019. For an overall understanding of how each code set is effected see below for individual stats for this year:

  • New CM Codes = 273
  • Revised CM Codes = 30
  • Deleted CM Codes = 21
  • New PCS Codes = 734
  • Revised PCS Codes = 2
  • Deleted PCS Codes = 2,056

To learn more about the individual changes and how they could affect your facility in FY 2020, join us on September 5th for an overview of the upcoming changes for 2020. A more detailed discussion will include:

  • New CM/PCS codes
  • Revised CM/PCS codes
  • Removed CM/PCS codes
  • CC/MCC changes
  • Revised exclusions to the CC list related to MS-DRGs

Centers for Disease Control and Prevention, July 26, 2019
Centers for Medicare and Medicaid, August 2, 2019
Federal Register, August 16, 2019