CMS Pub. 100-04, ch. 3, § 190.5.1

On claims with discharges before October 1, 2007, the IPF PPS provides adjustments for

15 designated DRGs. On claims with discharges on or after October 1, 2007, the IPF PPS

provides adjustments for 17 designated MS-DRGs. On claims with discharges on or after

October 1, 2024, the IPF PPS provides adjustments for 19 designated MS-DRGs.

Payment is made under the IPF PPS for claims with a principal diagnosis included in

Chapter Five of the International Classification of Diseases (ICD-9- or ICD-10 as

applicable) or the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition,

Text Revision (DSM-V-TR). The language about the source of the principal diagnosis

code is from our regulations at 42 CFR 412.27, and has been in place since 2006, but there

have since been updates to the versions of these code sets.

In a final rule published on September 5, 2012 (77 FR 54664), the Secretary of HHS

adopted the ICD–10–CM and ICD–10–PCS, in place of the ICD–9–CM, as the standard

medical data code sets for HIPAA covered entities. Because we are required to use the

HIPAA standards, effective October 1, 2015, IPF claims for eligible patients must have a

psychiatric principal diagnosis that is listed in the ICD–10–CM. It should be noted that the

DSM codes map to ICD-10 codes, but the mapping is not exclusive to chapter 5 of the

ICD–10–CM, as it was with ICD–9–CM.

Nevertheless, only those claims with diagnoses that group to a psychiatric DRG/MS-DRG

will receive the DRG adjustment in addition to all other applicable adjustments. Although

the IPF will not receive a DRG adjustment for a principal diagnosis not found in one of

the following psychiatric DRGs/MS-DRGs, the IPF will receive the Federal per diem base

rate and all other applicable adjustments.

IPFs must submit claims providing the principal diagnosis. To classify the case to the

appropriate DRG/MS-DRG, the GROUPER software for the hospital IPPS is used and the

IPF PRICER applies the appropriate adjustment factor to the Federal per diem base rate.

Changes to the ICD coding system are addressed annually in the IPPS proposed and final

rules published each year. The updated codes are effective October 1 of each year and

must be used to report diagnostic or procedure information.

(v25) MS-DRG

MS-DRG Descriptions Adjustment

Factor

056

Degenerative nervous system disorders w

MCC

1.12

057 Degenerative nervous system disorders

w/o MCC

1.11

876 O.R. procedure w principal diagnoses of

mental illness

1.29

880 Acute adjustment reaction & psychosocial

dysfunction

1.08

881 Depressive neuroses 1.06

882 Neuroses except depressive 1.02

883 Disorders of personality & impulse

control

1.17

884 Organic disturbances & mental

retardation

1.08

885 Psychoses 1.00

886 Behavioral & developmental disorders 1.07

887 Other mental disorder diagnoses 1.00

894 Alcohol/drug abuse or dependence, left

AMA

0.86

895 Alcohol/drug abuse or dependence w

rehabilitation therapy

0.90

(v25) MS-DRG

MS-DRG Descriptions Adjustment

Factor

896 Alcohol/drug abuse or dependence w/o

rehabilitation therapy w MCC

1.00

897 Alcohol/drug abuse or dependence w/o

rehabilitation therapy w/o MCC

0.95

917 Poisoning and toxic effects of drugs w

MCC

1.19

918 Poisoning and toxic effects of drugs w/out

MCC

1.12

947 Signs and Symptoms w MCC 1.12

948 Signs and Symptoms w/out MCC 1.09