The Hip Revision That Loses $13,047 on October 1

CR 14519 is maintenance. It updates one list once a year, and the MLN article carrying it runs two pages.

The list decides when a device credit comes out of an inpatient payment. For FY 2027 it loses eight MS-DRGs and gains three, which is a lot of turnover for a recurring update.

The eight left because CMS deleted them.

"What does a case pay after its severity ladder disappears?"

MS-DRGs 466, 467 and 468, revision of hip or knee replacement with MCC, with CC, and without CC/MCC, stop existing for discharges on or after October 1. One base MS-DRG 449 replaces all three. On the cardiac side, the five pacemaker DRGs, 258 through 262, become two: 210 with MCC and 211 without.

Why Eight DRGs Left the List

The hip and knee half was an accident of GROUPER plumbing.

While building the periprosthetic joint infection DRGs, CMS found that cluster restrictions under MDC 08 were misrouting cases, removed the restrictions, and re-ran the analysis. Cases redistributed across MDC 08, and 466, 467 and 468 came out the other side too small to keep their splits.

CMS's own subgroup criteria did the rest. The three-way split "failed to meet the criterion that there be at least 500 cases in the MCC group and that there is at least a 20 percent difference in average cost between the CC and NonCC group."

A two-way split on with MCC and without MCC failed the same 500-case test, and a two-way split on with CC/MCC and without failed the 20 percent test.

Nothing passed, so nothing splits. One DRG, one weight, every revision case.

The pacemaker consolidation is the cleaner story: CMS looked at replacement and revision cases and concluded that "in the 43 years since" those DRGs were created, "the resource utilization appears to now be aligned." A three-way split failed the 20 percent cost test, a two-way split on MCC met all five criteria, and the ladder went from five rungs to two.