SDOH and IP Reimbursement
Stay in the know about how proposed changes to SDOH codes could affect IP MS-DRG reimbursement.
 
Inpatient prospective payment system (IPPS) payment is made based on the use of hospital resources using various factors: the treatment of a patient’s severity of illness, the complexity of service, and/or the consumption of resources. Generally, a higher severity level designation of a diagnosis code results in a higher payment to reflect the increased hospital resource use.
 
CMS is proposing to change the severity of three ICD-10-CM diagnosis codes describing homelessness from a Non-CC to a CC (complication/comorbidity) designation. This will reflect the higher average resource costs of cases with these diagnosis codes compared to similar cases without these codes. The codes being considered are:

 

  • Z59.00 (Homelessness, unspecified)
  • Z59.01 (Sheltered homelessness)
  • Z59.02 (Unsheltered homelessness)
Please keep an eye on this change, as the final rule should be available in August 2023 and may affect payments for discharges on or after October 1, 2023.

 

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