How will the implementation of ICD-10-CM and ICD-10-PCS change the Medicare prospective payment systems (PPS)?

CMS has indicated that, initially, PPS case mix groups that rely on diagnosis and procedure codes (e.g. , Medicare severity diagnosis-related groups, Home Health Resource Groups) may not fundamentally change. Mapping methodologies will be used to map the ICD-10-CM and ICD-10-PCS codes to the case mix group where the corresponding ICD-9-CM code was assigned. In cases when there is not a straightforward map, CMS will select the case mix group that is believed to be the "best fit."

Once CMS has collected sufficient claims data coded in ICD-10-CM and ICD-10-PCS, appropriate refinements will be made to the case mix groups as warranted. More.

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