On May 29, 2016, a mapping change was implemented related to vaginal delivery claims. Note: This change appliesonly to facility providers that are on a DRG-based reimbursement method and use DRG Version 32 or earlier.

Background

Inquiries related to vaginal delivery claims with repair of perineum had been received from facility providers usingDRG Version 32 or earlier. In those cases, ICD-10 procedure code 0KQM0ZZ (Repair Perineum Muscle, OpenApproach) was grouping to a Non-Delivery MS-DRG, which in turn affected the payment.

For DRG Version 33, claims with this procedure code group to a Vaginal Delivery MS-DRG (i.e., MS-DRGs 774, 775).

Mapping change for ICD-10 procedure code 0KQM0ZZ

As of May 29, 2016, the DRG Grouper was updated so that these claims correctly group to the appropriate VaginalDelivery MS-DRG (MS-DRGs 774, 775) when submitted using DRG Version 32 or earlier. This change to the mapperfor ICD-10 procedure code 0KQM0ZZ is effective for dates of service on or after October 1, 2015, the ICD-10implementation date.

Affected claims are being reprocessed and grouped to the appropriate Vaginal Delivery MS-DRG based on theupdated logic. Providers should not resubmit claims.

If you have any questions about this mapping change for vaginal delivery claims, please contact your ProviderPartnership Associate or Network Coordinator.