Coding Tip: AHA COVID FAQs for ICD-10-PCS & New Technology
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
COVID-19 Treatment with New Technology Medication
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
The new ICD-10-PCS codes that are used for reporting the use of therapeutic substances in a COVID-19 patient do not impact the MS-DRG assignment. It is recommended that these codes be reported when applicable. This will allow help with tracking and determining effectiveness of each substance used with the COVID-19 patient outcomes. Some of them are New Technology (NTAP) payment drugs that the hospital would receive additional reimbursement for.
These new ICD-10-PCS codes are only assigned if they are being administered to treat COVID-19.
New Technology Payment (NTAP) codes are indicated by * These include those approved for FY2022 and prior years. Note that some “Codes in the New Technology” section of ICD-10-PCS may be new, but may not be approved for additional NTAP payment. They should still be reported.
Coders should only report the drug administration code once even if the drug is administered multiple times. If multiple drugs are used, each one would be reported once if the drug falls within the new technology drugs listed below.
All of the new technology drugs listed below are from New Technology Group 5.
If Dexamethasone is used to treat the COVID patient, and the facility wants it captured, it should be reported with the appropriate code from table 3E0 for introduction of anti-inflammatory drug. A code from the New Technology list would not be appropriate.
ICD-10-PCS | Specific Drugs to Treat COVID-19 | New Technology
- Remdesivir (VEKLURY©) (code is specific for route central vs. peripheral vein) XW033E5 for administration via peripheral vein or XW043E5 for administration via central vein (NTAP $2,028)
- Sarilumab (code is specific for route central vs. peripheral vein) XW033G5 for administration via peripheral vein or XW033G5 for administration via central vein
- Tocilizumab (code is specific for route central vs. peripheral vein) XW033H5 for administration via peripheral vein or XW043H5 for administration via central vein
- Olumiant® (baricitinib) Codes could be 3E0DXGC, 3E0G7GC, XW0DXF5, 3E0H7GC, XW0DXM6, XW0G7M6, XW0H7M6 (Did not receive FDA approval by 7/1/21. This will receive NCTAP for Covid payments through FY2022 but not for new technology.
ICD-10-PCS | Convalescent Plasma and Globulins to Treat COVID-19 | New Technology
- Convalescent Plasma (code is specific for route central vs. peripheral vein) XW13325 for administration via peripheral vein or XW14325 for administration via central vein
- Effective 10/1/21 – High-Dose Intravenous Immune Globulin (code is specific for central vs peripheral vein) XW133D7 for peripheral vein or XW143D7 for central vein administration
- Effective 10/1/21 – Hyperimmue Globulin (code is specific for central vs peripheral vein) XW133E7 for peripheral vein or XW143E7 for central vein administration
ICD-10-PCS | Drugs Not Classified Elsewhere | New Technology
- Introduction of Other New Technology Therapeutic Substance into Subcutaneous tissueXW013F5
- Introduction of Other New Technology Therapeutic Substances (code is specific for route central vs. peripheral) XW033F5 for administration via peripheral vein or XW043F5 for administration via central vein
- XW0DXF5 Introduction of other new technology therapeutic substance into mouth and pharynx, external approach, new technology group 5 for oral meds (or other specific XW0DX- code as they become available in oral form)
Coders should follow the guidance for reporting COVID-19 provided by the AHA. This is updated frequently and should be reviewed with each revision. If you are not familiar with the AHA FAQ for coding COVID-19 cases, please visit https://www.codingclinicadvisor.com/faqs-icd-10-cm-coding-covid-19 and download the most current version.
American Hospital Association (AHA) Frequently Asked Questions Regarding ICD10-CM/PCS Coding for COVID-19, Revised August 27, 2021
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.