MCC and CC List (Major Complications or Comorbidities) for CMS MS-DRG Explained.

Here is a what hospitalist and hospital documentation has become. There were some dramatic changes in  2008 to the inpatient prospective payment system (IPPS) that defined  how hospitals get paid by Medicare.  The over 800 diagnosis related groups (DRGs) now carry  modifiers for Medicare Severity-Diagnosis Related Group (MS-DRG)  Medicare has a list of  disease states that will increase hospital payments  based on whether the primary DRG diagnosis also carries a complicating or comorbid condition (CC) or major complicating or comorbid condition (MCC) that determines the MS-DRG.

Here is a list of the important resources you'll want to review with regards to CC and MCC. 
  • Read here for a great explanation of how the new Medicare payment process works. 
  • Here is the 2008 MS-DRG list from CMS.  
  • Here is the CMS table of  major complications or comorbidities (MCC) on Table 6J from  page 882-939. This file takes a little bit to load.  Head to these pages once it loads. 
  • Table 6K has the list of complications or comorbidities (CC)  on pages 940-1038 on the same CMS file listed right above from table 6J 
  • Here is a list of the ICD-10 CC and MCCI don't know when this is being implemented.
The amount of additional payment is significant and can lead to millions of dollars a year in additional revenue over thousands of patient admissions.  This process, however, takes cooperation with the medical staff.  Why?  Because physician documentation is the key.  Physicians or qualified non-physician personnel must document these qualifying complicating and major complicating or comorbid conditions in the chart for hospitals to collect their additional payment for resource utilization.

I've seen some simple data and have extrapolated what the potential hospital income could be if all doctors cooperated with this madness. The dollar:documentation ratio is phenomenal.  A little physician effort is worth millions of dollars to the hospital's bottom line.  Listen up doctor.   Instead of bitching about it, just document the truth you are being asked to document and you might help your hospital pay for a brand new doctor's lounge or maybe even help pay doctors for being on call.  This is one area where hospitalist value thrives. 

Every smart hospital in this country has hired specially trained nurses  to sift through hospital charts looking for evidence of diseases that, while documented, are not documented in a way that allows for a qualifying MCC or CC.   This is all perfectly legal.  In fact, if you're a hospital and you haven't implemented this type of program, you're going to lose.    CMS knows this.  They have even accounted for this response by reducing their increased severity of illness adjustment payment to account for an expected improvement in physician documentation compliance.  In other words,  CMS says they are going to pay hospitals more, but not as much as hospitals would expect because administrations are responding with better documentation programs.  It all just sounds so silly, doesn't it?

It is what it is.  This is what inpatient medical care has become.    It's one of the hospitalist advantages that many administrators don't factor in when they balk at paying lots of money to support hospitalist programs.    Trust me.  A hospitalist program that understands this cooperative effort can make a hospital more than ten times their return on investment by complying with these  robot documentation rules. 

Does me writing chronic respiratory failure with continuous home oxygen use required instead of O2 dependent COPD annoy the Hell out of me?  Not one bit.  It is a   waste of my time and offers no  benefit to the patient care.  But it is what it is.  I've come to accept that as a major part of my daily existence as a hospitalist.  Most of what I do on a daily basis is a waste of time.  Until we change the way we pay for health care, this will always be the case. 

The future is not going to be pretty.   We got exactly what we paid for in Medicare. In America, we  have to pay nurses north of $60,000 a year in salary plus benefits to round on patient charts in order to make sure we can collect more money to pay for more nurses to round on more charts.    This is our Medicare.   I would like to take this opportunity to formally welcome the millions of new Medicare Baby Boomers who will enter Medicare's Comedy Central this year.  Good luck. It's five -o-clock somewhere and there's a hospitalist just waiting  to unearth a complicating condition or major complicating condition under them scrubs of yours. 


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