============================================================================= Run Date: OCT 20, 2025 Designation: ICD*18*125 Package : ICD - DRG GROUPER Priority: EMERGENCY Version : 18 SEQ #117 Status: Released Compliance Date: OCT 27, 2025 ============================================================================= Subject: FY2026 ANNUAL DRG GROUPER UPDATE Category: - Routine - Other Description: ============ Patch ICD*18*125 provides the annual update to the Medicare Severity Diagnosis Related Group (MS-DRG) Grouper version 43. The purpose of this patch is to add code for the update that was posted in the Federal Register for fiscal year 2026. These changes were published on https://www.cms.gov and are part of the version 43 release, with an effective date of October 1, 2025. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ PLEASE NOTE: Be aware of the shortened compliance date. The changes included in this patch are posted in the Federal Register for Fiscal Year 2026 with an effective date of October 1, 2025. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ EHRM Impact Statement: ---------------------- - This patch can be installed at all sites, including EHRM converted sites. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- DRG MDC CATEGORY(83) Modified DRG MDC CATEGORY DRG(83.1) Modified DRG MDC CATEGORY DRG ORDER(83.11) Modified DRG MDC CATEGORY CASE(83.2) Modified DRG MDC CATEGORY CODE SETS(83.3) Modified DRG DIAGNOSIS(83.5) Modified DRG PDX EXCLUSION GROUPS(83.51) Modified DRG PROCEDURE(83.6) Modified DRG PROCEDURE GROUPS(83.61) Modified DRG HAC GROUPS(83.7) Modified DRG HAC CODE SETS(83.71) Modified DRG(80.2) Modified Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Remote Procedures Associated: Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A Additional Information: N/A New Service Requests (NSRs): N/A Patient Safety Issues (PSIs): N/A Defect Tracking System Ticket(s) & Overview: ============================================ 1)INC39226194-Annual update of VistA-DRG Application Problem: -------- The purpose of this patch is to add code for the update that was posted in the Federal Register for fiscal year 2026. These changes were published on https://www.cms.gov and are part of the version 43 release, with an effective status of October 1, 2025. 83X file Changes include: I. Added 4 new MDC Categories II. Added 5 DRGs III. Added 13 new Code Sets IV. Edited 18 MDC categories V. Inactivated 6 DRGs VI. Inactivated 7 MDC categories 80.2 file Changes include: Deactivated DRGs MS-DRG MDC TYPE MS-DRG TITLE 077 01 MED HYPERTENSIVE ENCEPHALOPATHY WITH MCC 078 01 MED HYPERTENSIVE ENCEPHALOPATHY WITH CC 079 01 MED HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC 294 05 MED DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC 295 05 MED DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC 509 08 SURG ARTHROSCOPY Added DRGs 209 05 SURG COMPLEX AORTIC ARCH PROCEDURES 213 05 SURG ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES 318 05 SURG PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE 359 05 SURG PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC 360 05 SURG PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC Resolution: ----------- Updated the 83x files (listed above) as well as the DRG (80.2) file. Created pre-init routines to facilitate the ICD file update process. Pre-Init Routines: ICD125A ICD125F ICD125G ICD125H ICD125I ICD125J ICD125K ICD125O ICD125P 2)INC39198666- VistA DRGs not calculating correctly Problem: -------- Patch ICD*18*125 addresses an issue where DRGs are not being calculated correctly due to missing exceptions in the DRG MDC CATEGORY CASE (#83.2) file for cases #21026 and #21027. Resolution: ----------- Created exceptions in the DRG MDC CATEGORY CASE (#83.2) file for cases #21026 and #21027. Test Sites: ----------- VISN 02 (Buffalo, NY) Montana HCS (Fort Harrison, MT) North Florida HCS (Gainesville, FL) Test Sites - SNOW Change Order #: --------------------------------- VISN 02 (Buffalo, NY): CHG0658966 Montana HCS (Fort Harrison, MT): CHG0658854 North Florida HCS (Gainesville, FL): CHG0659113 Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released using a host file. The host file is available at the following location: /srv/vista/patches/SOFTWARE/ICD_18_125.KID File Name Format ------------------------------ ICD_18_125.KID ASCII Patch Installation: ------------------- Pre/Post Installation Overview: N/A Pre-Installation Instructions: ------------------------------ It is recommended that this patch be installed during non-peak hours to minimize potential disruption to users. Additionally, installing during peak hours may lead to an unusually long install time. Do not interrupt the installation. Do not Queue this installation. If it is queued, it may hang and not finish installing. Installation can take 40 mins to one (1) hour. Create a backup of the following global file before continuing. When you are creating a backup of non-subscripted globals, you are saving the entire global. You should use the utility ^%GO for non-subscripted globals, and when prompted for a global, enter the global root (global name only, no open parenthesis, no file number and no commas, as shown below). Examples: Enter To create a Backup copy of: ------ -------------------------- ^ICDD entire ICDD global ^ICD entire ICD global Installation Instructions: -------------------------- 1. Use the Load a Distribution option contained on the Kernel Installation and Distribution System Menu to load the Host file. When prompted to "Enter a Host File:" enter /srv/vista/patches/SOFTWARE/ICD_18_125.KID 2. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter the patch or build name. (ex. ICD*18.0*125) NOTE: Using will not bring up a Multi-Package build even if it was loaded immediately before this step. It will only bring up the last patch in the build. B. Select the Backup a Transport Global option to create a backup message. You must use this option and specify what to backup; the entire Build or just Routines. The backup message can be used to restore the routines and components of the build to the pre-patch condition. i. At the Installation option menu, select Backup a Transport Global. ii. At the Select INSTALL NAME prompt, enter your build ICD*18.0*125. iii. When prompted for the following, enter "R" for Routines or "B" for Build. Select one of the following: B Build R Routines Enter response: Build iv. When prompted "Do you wish to secure this message? NO//", press and take the default response of "NO". v. When prompted with, "Send mail to: Last name, First Name", press to take default recipient. Add any additional recipients. vi. When prompted with "Select basket to send to: IN//", press and take the default IN mailbox or select a different mailbox. vii. Repeat step ii for each build in the host file. C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all of the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install. i. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer . ii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? yes//', answer . a. When prompted 'Enter options you wish to mark as 'Out Of Order':', select the following option: Menu Text Option Name --------- ----------- DRG Grouper [ICD DRG GROUPER] DRG Calculation [DG DRG CALCULATION] Load/Edit PTF Data [DG PTF SCREEN] Claims Tracking Edit [IBT EDIT TRACKING ENTRY] Enter/Edit Billing Information [IB EDIT BILLING INFO] DRG Information Report [DG PTF DRG INFORMATION OUTPUT] Press the Enter key when you are done selecting options. b. When prompted 'Enter options you wish to mark as 'Out Of Order':', press the Enter key. c. When prompted 'Delay Install (Minutes): (0 - 60): 0//', answer 0. Post-Installation Instructions: N/A Back-out/Roll Back Plan: ------------------------ Back-out will be done only with the concurrence and participation of development team and appropriate VA site/region personnel. The decision to back-out or rollback software will be a joint decision between development team, VA site/region personnel and other appropriate VA personnel. Due to the complexity of this patch, it is not recommended for back-out. In the event that an installer decides to back out this patch, the patch installer should contact the Enterprise Service Desk (ESD) to submit a help desk ticket to for referral to Sustainment. The sustainment team will need to issue a follow-on patch in order to comprehensively back-out this patch and restore the system to a functioning state. Routine Information: ==================== The second line of each of these routines now looks like: ;;18.0;DRG Grouper;**[Patch List]**;October 20, 2000;Build 4 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ICD125A Before: n/a After: B69852743 **125** Routine Name: ICD125F Before: n/a After: B70218427 **125** Routine Name: ICD125G Before: n/a After: B84823369 **125** Routine Name: ICD125H Before: n/a After: B83108134 **125** Routine Name: ICD125I Before: n/a After: B74812983 **125** Routine Name: ICD125J Before: n/a After: B72297830 **125** Routine Name: ICD125K Before: n/a After: B76896900 **125** Routine Name: ICD125O Before: n/a After: B3498979 **125** Routine Name: ICD125P Before: n/a After: B3592006 **125** ============================================================================= User Information: Entered By : III Date Entered : JUN 05, 2025 Completed By: Date Completed: OCT 20, 2025 Released By : Date Released : OCT 20, 2025 ============================================================================= Packman Mail Message: ===================== No routines included