CMS seeks comments on hip fracture codes in connection with CJR program

AHA News Now

The Centers for Medicare & Medicaid Services seeks comments on a draft ICD-9-CM code list for hip fracture diagnoses that it has developed in connection with its new payment model that will bundle payment to acute care hospitals for hip and knee replacement surgery. The Comprehensive Care for Joint Replacement Payment Model will begin April 1 for hospitals in 67 geographic areas. The hip fracture diagnosis code list will be used to determine historical episode spending and develop the initial target prices for the CJR model.  Specifically, CMS will establish different target prices for episodes with and without hip fracture in order to capture additional patient-driven episode expenditure variation. The draft code list is available on the CJR website. CMS will assess suggested codes based on whether they are sufficiently specific to represent a bone fracture for which a physician could determine that a hip replacement could be the primary surgical treatment and whether it is the primary reason for the initial episode hospitalization. Comments must be submitted by 5 p.m. ET on Nov. 30 to cjr@cms.hhs.gov. CMS will post the final ICD-9-CM code list to the same website and will repeat the process for developing ICD-10-CM codes prior to the program launch on April 1.

Topic: Advocacy and Public Policy
Tag: ICD-10

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