CC/MCC changes in 2027 IPPS final rule: We summarize them for you

The 2027 IPPS final rule includes several CC/MCC reimbursement changes to diagnoses you should be aware of.

Watch for these in the documentation and report them and/or query if clinical indicators present. An audit now to confirm their presence or absence is a good strategy. They take effect Oct. 1.

For example, hypoglycemia (i.e., low blood sugar) post bariatric or other postprocedural is now a CC.

J4B Pulmonary mycetoma is an MCC; this condition is a defined by a fungus ball growing inside old lung cavities left by conditions like tuberculosis, sarcoidosis, or emphysema, and appears on X-rays or CT scans as a rounded mass inside a cavity.

How common is this? Something to discuss with your radiologists.

Lots of new cardiomyopathy codes, cardiology coders.

BMI codes Z68.18 (BMI 18.4 or less, adult) and Z68.19 (BMI 18.5-19.9, adult) seem like codes your and/or your coding staff will be regularly capturing.

Below is the complete list of changes, condensed to eliminate redundancy. For example M86.8X, Other osteomyelitis, includes a range of codes by anatomic site. O00 (that’s an O followed by two zeros), has a range of new CCs for ectopic pregnancies.

Note that some of these “new” CCs are old CC conditions that require further specificity, so we included the CC deletion list as well. No MCCs were deleted.

CMS decided that homelessness and inadequate housing were no longer worthy of CC designation/additional payment to the hospital, but of course (and as with all these codes) you should be reporting them regardless of payment status.

Coding accuracy is the reason for the season, and they may also hold weight in other methodologies beyond the IPPS.

New MCCs

• J4B Pulmonary mycetoma
• K6A.01 Prevesical abscess
• K6A.09 Other pelvic abscess

New CCs

• C78.31 Secondary malignant neoplasm of larynx
• C78.32 Secondary malignant neoplasm of pharynx
• C79.83 Secondary malignant neoplasm of oral cavity
• E89.830 Post bariatric hypoglycemia
• E89.838 Other postprocedural hypoglycemia
• I42.00 Dilated cardiomyopathy, unspecified
• I42.01 Familial-genetic dilated cardiomyopathy
• I42.09  Other dilated cardiomyopathy
• I42.81 Arrhythmogenic cardiomyopathy
• I42.89 Other cardiomyopathies not elsewhere classified
• I47.22  Catecholaminergic polymorphic ventricular tachycardia [CPVT]
• K31.B   Hypertrophic pyloric stenosis, in childhood
• K6A.8   Other diseases of the pelvis, not elsewhere classified
• M86.8X series, Other osteomyelitis, further specified (see link below)
• O00 series, Ectopic pregnancy further specified (see link below)
• Q87.A  Loeys-Dietz syndrome
• Z68.18 Body mass index [BMI] 18.4 or less, adult
• Z68.19 Body mass index [BMI] 18.5-19.9, adult

CC DELETIONS

• I42.0 Dilated cardiomyopathy
• I42.8 Other cardiomyopathies
• M86.8X1 through M86.8X8 Other osteomyelitis (less specified)
• Z59.00 Homelessness unspecified
• Z59.01 Sheltered homelessness
• Z59.02 Unsheltered homelessness
• 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
• Z68.1    Body mass index [BMI] 19.9 or less, adult