Version Change Implementation ¶
MSDRG Process:
We need to download the MSDrg file corresponding to FY2019 using the Following URL.In that URL you need to find Table5 heading under this MSDrg file is available.
URL:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Proposed-Rule-Home-Page-Items/FY2019-IPPS-Proposed-Rule-Tables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending (OR) https://www.cms.gov/medicare/acute-inpatient-pps/fy-2021-ipps-final-rule-home-page
Note:If you want to Download Previous Year just you need to replace the year 2018 instead of 2019 in the URL.
Once we download the file we need to do two Steps which are given below.
Step1: Import the MSDrg file to a Standard table which is "MSDrgWeight" on MedmineMaster Database.
Step2: Once Import process was done then you need to update TransferDrg based on (PostAcuteDrg condition or using following query) to MSDrgWeight.
Query:
Update MedmineMaster Set TransferDrg='T*' where GrouperVersion=36 and PostAcuteDrg='YES'
APRDRG Process:
We need to download the APRDrg file corresponding to FY2019 using the Following URL.In that URL you need to find CALIFORNIA/NON-BORDER OUT OF STATE heading under this APRDrg file is available with two Formats like Excel(Pricing Calculator SFY 18/19-180710) and PDF(Hospital Characteristics File SFY 18/19-180710).
URL:
https://www.dhcs.ca.gov/provgovpart/Pages/DRG-Pricing-SFY2018-19.aspx
Note:If you want to Download Previous Year just you need to replace the year 2018 instead of 2019 in the URL.
Once we download the file we need to do two Steps which are given below.
Step1: We Need to Format the Excel file as per our requirement to import.This process is nothing but Splitting of SOI from DrgCode.
Step2: Import the APRDrg file to a Standard table which is "APRDrgWeight" on MedmineMaster Database.
ICD10 Process:
October 1, 2018 will mark the third mandated update to the ICD-10-CM and ICD-10-PCS classification systems. Whether you are a provider, payer, auditor, or vendor, anyone who deals with medical insurance claims needs to be aware of these changes and how to interpret them.
The knowledge needed to: Apply the numerous coding updates and revisions Identify the deleted codes and determine what to use instead Recognize potential documentation needs Understand code change rationale Implement guideline revisions and apply them with confidence
To know the Version updates for ICD10 - CM codes from CMS website -> use the below url
https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html and Here we found all versions like 2017, 2018, and 2019 with Zip files like
2019 Code Descriptions in Tabular Order [ZIP, 2MB] 2019 Code Tables and Index [ZIP, 18MB] 2019 Addendum [ZIP, 685KB] 2019 Conversion Table [ZIP, 73KB] 2019 Coding Guidelines [PDF, 604KB] 2019 POA Exempt Codes [ZIP, 1MB]
The 2019 ICD-10-CM files above contain information on the ICD-10-CM updates for FY 2019. These 2019 ICD-10-CM codes are to be used for discharges occurring from October 1, 2018 through September 30, 2019 and for patient encounters occurring from October 1, 2018 through September 30, 2019.
Step 1: UnZip the file 2019 Code Descriptions in Tabular Order
Step 2: Open the file named with icd10cm_codes_addenda_2019.txt
Step 3: Separate the codes like Additions , Deletions and Revised codes in Editplus or Excel.
Step 4: Add the Code Additions,Code Deletions and Revised codes to Standard table DXDesc in MedmineMaster with EffectiveYearFrom as October 1, 2018 and EffectiveYearTo as September 30, 2019.
Queries to Update Icd Version Changes :--
Update the EffectiveYearTo field for All Codes..... update CMS_DXCodeDesc set EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearTo='2020-09-30 23:59:59.000'
Update EffectiveYear From and To fields for Newly Added Codes... update CMS_DXCodeDesc set EffectiveYearFrom='2020-10-01 00:00:00.000' , EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearFrom is null
Update EffectiveYearTo field for Deleted codes for this version.. update CMS_DXCodeDesc set EffectiveYearTo='2020-09-30 23:59:59.000' where IcdCode in('place Deleted codes')
Change Code format by placing dot(.) after three characters.... update CMS_DXCodeDesc set Icd10Code=LEFT(ICD10Code,3)+'.'+SUBSTRING(ICD10Code,4,LEN(ICDCode)) where EffectiveYearFrom='2020-10-01 00:00:00.000' and LEN(ICD10Code)>3 and ICD10Code not like '%.%'
Update IcdLevel Field based on code length... update CMS_DXCodeDesc set IcdLevel=5 from CMS_DXCodeDesc where EffectiveYearFrom='2020-10-01 00:00:00.000' and LEN(ICDCode)=7
POA Exemptions:
Step 5: UnZip the file 2019 POA Exempt Codes
Step 6: Choose the files POAexemptAddCodes2019.xlsx, POAexemptDeleteCodes2019.xlsx,POAexemptReviseCodes2019.xlsx for Addition, Deletion and Revise respectively.
Step 7: Make the Changes to Standard table POAExemptions in MedmineMaster with EffectiveYearFrom as October 1,2018 and EffectiveYearTo as September 30, 2019.
PCS Process:
To know the Version updates for ICD10-PCS codes from CMS website -> use the below url
https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-PCS-and-GEMs.html
2019 Official ICD-10-PCS Coding Guidelines [ZIP, 353KB] 2019 Version Update Summary [ZIP, 212KB] 2019 ICD-10-PCS Code Tables and Index [ZIP, 7MB] 2019 ICD-10-PCS Codes File [ZIP, 585KB] 2019 ICD-10-PCS Order File (Long and Abbreviated Titles) [ZIP, 1MB] 2019 ICD-10-PCS Addendum [ZIP, 608KB] 2019 ICD-10-PCS Conversion Table [ZIP, 1MB]
The 2019 ICD-10 Procedure Coding System (ICD-10-PCS) files above contain information on the ICD-10-PCS updates for FY 2019. These 2019 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2018 through September 30, 2019.
Step 1: UnZip the 2019 ICD-10-PCS Codes File
Step 2: Open the file named with codes_addenda_2019.txt
Step 3: Separate the codes like Additions , Deletions and Revised codes in Editplus or Excel.
Step 4: Add the Code Additions,Code Deletions and Revised codes to Standard table PcsDesc in MedmineMaster with EffectiveYear From as October 1, 2018 and EffectiveYearTo as September 30, 2019.
Queries to Update PCS Version changes... Update the EffectiveYearTo field for All Codes..... update CMS_PcsCodeDesc set EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearTo='2020-09-30 23:59:59.000'
Update EffectiveYear From and To fields for Newly Added codes... update CMS_PcsCodeDesc set EffectiveYearFrom='2020-10-01 00:00:00.000' , EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearFrom is null
CC/MCC,PdxownCCMCC and CCExlusions Process:
To know the Version updates for CC/MCC codes from CMS website -> use the below url
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Tables.html
Tables 6A-6K and Tables 6P.1c-6P.1f [ZIP, 1MB]
Use the following text files which are extracted from the above ZIP file to update the CC/MCC Addtions, Deletions and Exclusions.
Step 1: UnZip the Tables 6A-6K and Tables 6P.1c-6P.1f File
Step 2: Open the files named with following list
CMS-1694-F Table 6I.1 - Additions to the MCC List - FY 2019.txt CMS-1694-F Table 6I.2 - Deletions to the MCC List - FY 2019.txt CMS-1694-F Table 6J.1 - Additions to the CC List - FY 2019.txt CMS-1694-F Table 6J.2 - Deletions to the CC List - FY 2019.txt CMS-1694-F Table 6K - Complete List of CC Exclusions - FY2019.txt
Step 3: Make the Changes to Standard tables which are MSDRGCCExclusions and PDXExclusions in MedmineMaster with EffectiveYearFrom as October 1,2018 and EffectiveYearTo as September 30, 2019
Queries to Update CC/MCC version changes ... update CMS_CCMCCCode set EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearTo='2020-09-30 23:59:59.000' update CMS_CCMCCCode set EffectiveYearFrom='2020-10-01 00:00:00.000' , EffectiveYearTo='2021-09-30 23:59:59.000' where EffectiveYearFrom is null update CMS_CCMCCCode set EffectiveYearTo='2020-09-30 23:59:59.000' where dxCode in('deleted codes')
HacCodes Process:
To Know the version updates for HospitalAcquiredConditions from CMS site :
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/icd10_hacs (OR) https://www.cms.gov/ICD10Manual/version36-fullcode-cms/fullcode_cms/P0001.html
Appendix I Hospital Acquired Conditions (HACS) List
Use the above link to get HAC codes Complete List.
Step 1: Click on the link – Appendix I Hospital Acquired Conditions (HACS) List.
Step 2: Copy all the codes and descriptions from HAC 01 to Hac 14
Step 3: Insert the data to Standard table like HacCodes in MedmineMaster with EffectiveYearFrom as October 1,2018 and EffectiveYearTo as September 30, 2019.
Note
1 There are no files for PdxownCCMCC Codes in this version.In previous versions following are flies
Table 6L.- Principal Diagnosis Is Its Own MCC List
Table 6M.- Principal Diagnosis Is Its Own CC List
2 Check once for these files and also need to update to Standard table MSDRGPdxOwnCcMcc in MedmineMaster.
3 Additions means new codes added in this version, for these we need to add newly with effective years to corresponding table.
4 Deletions means the listed codes are not a valid ones from now, so need to restrict those codes upto September 30th 2018 by changing the EffectiveYearTo field corresponding tables.
5 Revised means the Code Description is changed from previous version to current version, so need to update only description corresponding codes in tables.