============================================================================= Run Date: JAN 02, 2018 Designation: ICD*18*93 Package : ICD - DRG GROUPER Priority: Mandatory Version : 18 SEQ #84 Status: Released Compliance Date: JAN 12, 2018 ============================================================================= Associated patches: (v)ICD*18*90 <<= must be installed BEFORE `ICD*18*93' Subject: FY2018 ANNUAL DRG GROUPER UPDATE Category: - Routine - Other Description: ============ This patch provides the annual update to the Medicare Severity Diagnosis Related Group (MS-DRG) Grouper version 35. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ PLEASE NOTE: Be aware of the shortened compliance date. The dates listed in the patch are accurate as the FY2018 annual patch was delayed. The changes included in this patch were effective as of 10/1/2017 per the Federal Register Vol. 82, No. 155, dated August 14, 2017. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ASSOCIATED TICKET: ================== 1) I17235153FY18 - FY2018 Annual DRG Grouper update ASSOCIATED NSRs: ================ N/A PARTICIPATING TEST SITES: ========================= VISN 2 - Upstate New York HCS VA North Florida/South Georgia HCS TICKET OVERVIEW: ================ 1) I17235153FY18 - FY2018 Annual DRG Grouper update The following changes are published in the Federal Register, Vol. 82, No. 155, dated August 14, 2017 with an effective date of October 1, 2017. All page references below are for this annual update and resource documents can be found at https://www.cms.gov/. Changes include: I. Revised DRGs. II. Revised DRG relative weights & average length of stay (ALOS) values for all DRGs. III. DRG Reclassification changes to the Grouper. IV. Additional DRG-related data for the new ICD codes introduced by patch LEX*2.0*113 (released October 5, 2017). This is a summary of the additions/changes made: I. Routine ICD1893A was written to update the DRG file (#80.2). NEW DRGs for FY 2018 -------------------- n/a INACTIVATED DRGs for FY 2018 ---------------------------- MS-DRG 984 MS-DRG 985 MS-DRG 986 II. Routine ICD1893A is used to update the finalized values for DRG relative weights and average length of stay (ALOS). III. DRG RECLASSIFICATION. Changes to other DRGs: ---------------------- 1. MDC 1 (p.38015) Effective 10/1/2017 ICD-10 diagnosis code R53.2 (Functional quadriplegia) will be assigned to MS-DRGs 947 and 948 (Signs and Symptoms with MCC and without MCC, respectively). 2. MDC 1 (p.38019) Effective 10/1/2017 reassignment of all cases with a principal diagnosis of epilepsy and one of the following ICD-10-PCS code combinations capturing cases with the neurostimulator generators inserted into the skull (including cases involving the use of the Responsive Neurostimulator (RNS) System), to MS-DRG 023, even if there is no MCC reported: 0NH00NZ (Insertion of neurostimulator generator into skull, open approach), in combination with 00H00MZ (Insertion of neurostimulator lead into brain, open approach) 0NH00NZ (Insertion of neurostimulator generator into skull, open approach), in combination with 00H03MZ (Insertion of neurostimulator lead into brain, percutaneous approach) 0NH00NZ (Insertion of neurostimulator generator into skull, open approach), in combination with 00H04MZ (Insertion of neurostimulator lead into brain, percutaneous endoscopic approach). 3. MDC 1 (p.38022) Effective 10/1/2017 reassignment of the ICD-10-CM diagnosis codes listed on page 38020 of the Federal Register that are currently assigned to MS-DRGs 067 and 068 and the ICD-10-CM diagnosis codes currently assigned to MS-DRG 069 to the GROUPER logic for MS-DRGs 061, 062, and 063 when those conditions are sequenced as the principal diagnosis and reported with an ICD-10-PCS procedure code describing use of a thrombolytic agent (for example, Tissue Plasminogen Activator (TPA). 4. MDC 2 (p.38022) Effective 10/1/2017 reassignment of the following ICD-10-CM diagnosis codes from MS-DRGs 124 and 125 to MS-DRGs 917 and 918 for FY 2018: T49.5X1A; T49.5X2A; T49.5X3A; and T49.5X4A 5. MDC 5 (p.38024) Revision of the titles for MS-DRGs 246 and MS-DRG 248. The title of MS-DRG 246 to 'Percutaneous Cardiovascular Procedures with Drug-Eluting Stent with MCC or 4+ Arteries or Stents' and the title of MS-DRG 248 to 'Percutaneous Cardiovascular Procedures with Non-Drug-Eluting Stent with MCC or 4+ Arteries or Stents' effective October 1, 2017 for ICD-10 MS-DRGs Version 35. 6. MDC 5 (p.38027) Reassign the four percutaneous mitral valve replacement procedure codes listed on page 38026 of the Federal Register from MS-DRGs 216 through 221 to MS-DRGs 266 and 267 and assign the eight new procedure codes (also listed on page 38026 of the Federal Register) that describe percutaneous and transapical, percutaneous tricuspid valve replacement procedures to MS-DRGs 266 and 267 effective October 1, 2017 for ICD-10 MS-DRGs Version 35. 7. MDC 8 (p.38029) Reassigning the following Total Ankle Replacement (TAR) procedure codes from MS DRG 470 to MS DRG 469, even if there is no MCC reported: 0SRF0J9; 0SRF0JA; 0SRF0JZ; 0SRG0J9; 0SRG0JA; and 0SRG0JZ for FY2018. Also changing the titles of MS-DRGs 469 and 470 to the following to reflect these MS-DRG reassignments: MS-DRG 469: 'Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity with MCC or Total Ankle Replacement'; and MS-DRG 470: 'Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC'. 8. MDC 14 (p.38038) Remove ICD-10-CM diagnosis codes O09.41, O09.42 and O09.43, which describe supervision of pregnancy, from MS-DRG 782 and reassign them to MS-DRG 998 (Principal Diagnosis Invalid as Discharge Diagnosis) in the ICD-10 MS-DRGs Version 35, effective October 1, 2017. 9. MDC 14 (p.38039) Update the following in the ICD-10 MS-DRGs Version 35, effective October 1, 2017: Move ICD-10-CM diagnosis code O75.1 from the list of principal or secondary diagnosis under the second condition-complicating diagnosis for MS-DRG 774 to the secondary diagnosis list only; and Add ICD-10-CM diagnosis code O75.1 to the principal diagnosis list GROUPER logic in MS-DRGs 769 and 776. 10. MDC 15 (p.38040) Add the 14 diagnosis codes describing 'observation and evaluation of newborns for suspected conditions that are ruled out' listed on page 38039 of the Federal Register to the GROUPER logic for MS-DRG 795 (Normal newborn) in the ICD-10 MS-DRGs Version 35, effective October 1, 2017. 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 1. Retrieve the KIDS distribution host file. This patch will be distributed in a host file due to the amount of data contained in the patch. The name of the host file is: ICD_18_93.KID Sites can retrieve VistA software from the following Secure File Transfer Protocol (SFTP) addresses. The preferred method is to SFTP the files from: download.vista.domain.ext This will transmit the files from the first available SFTP server. Sites may also elect to retrieve software directly from a specific server as follows: Hines domain.ext Salt Lake City domain.ext The ICD_18_93.KID host file is located in the directory. Use ASCII Mode when downloading the file. 2. Load the KIDS distribution that is contained in file ICD_18_93.KID using the Load a Distribution option on the Installation menu. 3. Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... 4. From this menu, you may elect to use the following options (When prompted for the INSTALL NAME, enter ICD*18.0*93): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. 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 components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. Use the Install Package(s) option and select the package ICD*18.0*93: a. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. b. When prompted 'Want to DISABLE Scheduled Options and Menu Options and Protocols? YES//', answer YES. When prompted, 'Enter options you wish to mark as 'Out Of Order':', enter: 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] When prompted, 'Enter protocols you wish to mark as 'Out of Order':', enter: 6. Please be aware that routine ICD1893P is deleted by design during the install process. Therefore, the ICD1893P post-install checksum is not applicable. Routine Information: ==================== The second line of each of these routines now looks like: ;;18.0;DRG Grouper;**[Patch List]**;Oct 20, 2000;Build 6 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ICD1893A Before: n/a After: B66184285 **93** Routine Name: ICD1893F Before: n/a After: B59499713 **93** Routine Name: ICD1893G Before: n/a After: B63144983 **93** Routine Name: ICD1893H Before: n/a After: B59999567 **93** Routine Name: ICD1893I Before: n/a After: B57731756 **93** Routine Name: ICD1893J Before: n/a After: B60214816 **93** Routine Name: ICD1893K Before: n/a After: B60282987 **93** Routine Name: ICD1893O Before: n/a After: B2996468 **93** Routine Name: ICD1893P Before: n/a After: B2854462 **93** ============================================================================= User Information: Entered By : Date Entered : SEP 01, 2017 Completed By: Date Completed: DEC 29, 2017 Released By : Date Released : JAN 02, 2018 ============================================================================= Packman Mail Message: ===================== No routines included