New CCs and MCCs, TEAM model implemented, and new quality measures among other changes
By Brian Murphy
The 2025 Inpatient Prospective Payment System (IPPS) final rule is out, and takes effect Oct. 1, 2024.
These rules are always long and this one is no exception, but here’s some interesting bits I pulled out for CDI and coding professionals.
Acute care hospitals will receive a 2.9% payment bump.
Adoptions of portions of the new mandatory alternative payment model, TEAM (Transforming Episode Accountability Model). See p. 21 of the final rule below.
Increased severity designation of seven ICD-10-CM codes that describe inadequate housing and housing instability from non-complication or comorbidity (NonCC) to CCs, based on the higher average resource costs of these cases. These fall in the Z59 series:
- Z59.10, Inadequate housing, unspecified
- Z59.11, Inadequate housing environmental temperature
- Z59.12, Inadequate housing utilities
- Z59.19 , Other inadequate housing
- Z59.811, Housing instability, housed, with risk of homelessness
- Z59.812, Housing instability, housed, homelessness in past 12 months
- Z59.819, Housing instability, housed unspecified
Four new MCCs, including:
- I26.03 Cement embolism of pulmonary artery with acute cor pulmonale
- I26.04 Fat embolism of pulmonary artery with acute cor pulmonale
- I26.95 Cement embolism of pulmonary artery without acute cor pulmonale
- I26.96 Fat embolism of pulmonary artery without acute cor pulmonale
104 new CCs, too many to list here but primarily codes related to lymphoma types (C81-C88 series), anorexia and bulimia (F50 series), epilepsy, GI repairs, and of course the inadequate housing codes above. Your friend is Table 6J.1.
18 deleted CCs, mostly non-specific codes that are now included in the new CC list
Seven new quality measures, deletion of five quality measures, and modification of two measures in the Hospital Inpatient Quality Reporting Program. Note that these measures can be impacted by more than just clinical care; accurate diagnosis and procedure coding can move patients in and out of them.
The seven new measures include the following; read for more detail because implementation dates are staggered:
- Hospital Harm – Falls with Injury eCQM, with inclusion in the eCQM measure set
- Hospital Harm – Postoperative Respiratory Failure eCQM, with inclusion in the eCQM measure set
- Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications
- Patient Safety Structural Measure
- Age Friendly Structural Measure
- Catheter-Associated Urinary Tract Infection Standardized Infection Ratio measure stratified for oncology locations
- Central Line-Associated Bloodstream Infection Standardized Infection Ratio measure
CMS is modifying two current measures:
- Global Malnutrition Composite Score eCQM beginning with the CY 2026 reporting period/FY 2028 payment determination. This modification adds patients ages 18 to 64 to the current cohort of patients 65 years or older.
- Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure
CMS removed five payment measures effective June 30, 2024. These include Hospital-level, Risk-Standardized Payment Associated with a 30-Day Episode of Care for:
- Acute Myocardial Infarction
- Heart Failure
- Pneumonia
- Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty
CMS is also removing PSI-04, Death Among Surgical Inpatients with Serious Treatable Complications measure (associated with a July 1, 2023 – June 30, 2025 reporting period) and replacing it with the Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications measure described above.
The Hospital-Acquired Condition (HAC) Reduction Program and Hospital Readmissions Reduction Program remain unchanged; minor tweaks were made to the Hospital Value-Based Purchasing (VBP) Program related to the Person and Community Engagement Domain.
Resources
2025 IPPS final rule: https://public-inspection.federalregister.gov/2024-17021.pdf
2025 IPPS final rule home page (includes code tables): https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2025-ipps-final-rule-home-page
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