April 2022 Microdyn Updates for Ambulatory Payment Classifications (APC), and Diagnostic Related Group (DRG) CRs 108929, 109194, 109193, & 109516 

Jul 28, 2022

Effective July 16, 2022, we have updated MIHMS with the Centers for Medicare & Medicaid Services (CMS) quarterly updates. The following CMS documents provide the details of the updates:  

Implement the updated DRG grouper V39.1 for new COVID-19 ICD-10 diagnosis and procedure codes effective April 1, 2022. The following CMS document describes the 
ICD-10/MS-DRG update: https://www.cms.gov/files/document/r11255cp.pdf 

The following CMS document provides the details of the APC updates: 
April 2022 Integrated Outpatient Code Editor Specs: https://www.cms.gov/files/document/r11304cp.pdf 
April 2022 Update of the Hospital OPPS: https://www.cms.gov/files/document/r11305cp.pdf 

We have identified an issue where some APC claims were paying at zero. This update fixes the issue, and we will adjust claims that denied in error. No provider action is needed. 

We were also holding APC claims for a period of two weeks. Those claims are now being released for payment. 

For questions, please email Tiffany Norton or call her directly at 207 624-6934.