New Technology Add-On Payments (NTAP) For FY2021 – Part 4
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
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.
Section “X” New Technology
CMS provides incremental payment (in addition to the DRG payment) for technologies that qualify for NTAP. For FY2021 it is 65% of the costs of the new medical device or technology. In 2020, the agency finalized a 75% new technology add-on payment for certain antimicrobials. For many antimicrobials, CMS stated for FY2021 that they will not need to meet the requirement that it represent an advance that substantially improves, relative to technologies previously available. This was done to help facilitate treatments (especially during the COVID-19 pandemic.)
Section “X” is a separate place within ICD-10-PCS for certain new technology procedures (such as new technology drugs). Section “X” does not introduce any new coding concepts or unusual guidelines for correct coding and maintains continuity with the other sections in ICD-10-PCS. The same root operation and body part values are used in section “X” as in other sections. The seventh character in section “X” is used to indicate the new technology group. This is a number that changes each year that new technology codes are added. It is only used to indicate the year the code was created and all codes for that update year will have the same qualifier. The new technology drugs for FY2021 will have the qualifier/seventh character of “6” since this is the sixth year of ICD-10-PCS. You will see other new technology codes with numbers from previous years that are still being paid.
Section “X” codes are standalone codes. No additional codes from other sections in ICD-10-PCS are necessary for reporting as the specific procedure is described in the code title from section “X”.
New Technology section codes are easily found by looking in the ICD-10-PCS Index or the Tables. The name of the new technology device, substance or technology for a section “X” code is included as the main term. They are also listed under the main term “New Technology”.
New technology items have a new technology payment that is made in addition to the DRG payment for hospital inpatients. Missing new technology codes is a frequent error made by coders. Coders must familiarize themselves with the new technologies of each year.
New Technology Procedure Codes and Reimbursements for FY2021
Below are the codes that will be reimbursed as NTAP codes. There are 24 NTAP for FY2021. You may want to print this out and keep it handy or on your desktop for future reference. Some of the add on payments are astounding!
- ZEMDRI™(Plazonmicin). Next generation aminoglycoside antibiotic to treat multi-drug resistant gram-negative bacteria. Usually complicated UTI (cUTI) or pyelonephritis. The maximum payment a hospital can receive for this is $4,083.75 as a new technology add on payment.
- XW033G4 – Introduction of Plazomicin Anti-Infective into peripheral vein, percutaneous, new technology group 4
- XW043G4 – Introduction of Plazomicin Anti-Infective into central vein, percutaneous, new technology group 4
- AZEDRA® (Ultratrace® iobenguane Iodine-131) is a drug solution for IV use in patients with obenguane avid malignant and/or recurrent and/or unresectable pheochroomocytoma and paraganglioma (PPGL). These are rare with incidence of 2-8 people per million per year. Paragangliomas have a malignancy frequency of 25%. They are both neuroendocrine tumors. The maximum payment a hospital can receive for this is $98,150.00 as a new technology add on payment.
- XW033S5 – Introduce Iobenguane I-131 in Peripheral vein, percutaneous, new technology group 5
- XW043S5 – Introduce Iobenguane I-131 in Central vein, percutaneous, new technology group 5
- CABLIVI® (caplacizumab-yhdp) is a humanized bivalent nanobody administered through IV and subcutaneous injections to inhibit micro clot formation in adult patients how have been diagnosed with thrombotic thrombocytopenic purpura (aTTP). The maximum payment a hospital can receive for this is $33,215.00 as a new technology add on payment.
- XW013W5 – Introduction of Caplacizumab into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
- XW033W5 – Introduction of Caplacizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
- XW043W5 – Introduction of Caplacizumab into Central Vein, Percutaneous Approach, New Technology Group 5
- ELZONRIS™ (tagraxofusp-erzs) is a targeted therapy for treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) which is highly aggressive. Administered via infusion. The maximum payment a hospital can receive for this is $125,448.05 as a new technology add on payment.
- XW033Q5 – Introduce Tagraxofusp-erzs into peripheral vein, percutaneous, new technology group 5
- XW043Q5 – Introduce Tagraxofusp-erzs into central vein, percutaneous, new technology group 5
- AndexXa™ (Andexanet alfa) (coagulation factor Xa (recombinant), inactivated-zhzo)is an antidote used to treat patients who are receiving treatment with an oral Factor Xa inhibitor who suffer a major bleeding episode and require urgent reversal of direct and indirect Factor Xa anticoagulation. Patients at high risk for thrombosis, including those who have been diagnosed with atrial fibrillation (AF) and venous thrombosis (VTE), typically receive treatment using long-term oral anticoagulation agents. The maximum payment a hospital can receive for this is $18,281.25 as a new technology add on payment.
- XW03372 – Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal agent into peripheral vein, percutaneous, new technology group 2
- XW04372 – Introduction of Andexanet Alfa, Factor Xa Inhibitor Reversal agent into central vein, percutaneous, new technology group 2
- Balversa™ (Erdafitimib) indicated for the second-line treatment of adult patients who have been diagnosed with locally advanced or metastatic urothelial carcinoma whose tumors exhibit certain fibroblast growth factor receptor (FGFR) genetic alterations as detected by an FDA-approved test, and who have disease progression during or following at least one line of prior chemotherapy including within 12 months of neoadjuvant or adjuvant chemotherapy. The maximum payment a hospital can receive for this is $3,563.23 as a new technology add on payment.
- XW0DXL5 – Introduction of Erdafitinib Antineoplastic into mouth and pharynx, external, new technology group 5
- SPRAVATO (Esketamine) is a nasal spray used for treatment-resistant (major) depression (TRD). The maximum payment a hospital can receive for this is $1,014.79 as a new technology add on payment.
- 3E097GC – Administration and introduction of other therapeutic substance, other substance into nose, via natural or artificial opening
- XOSPATA® (gilteritinib). Is oral med indicated for the treatment of adult patients who have been diagnosed with relapsed or refractory acute myeloid leukemia (AML) with a FMS-like tyrosine kinase 3 (FLT3) mutation as detected by an FDA-approved test. The maximum payment a hospital can receive for this is $7,312.50 as a new technology add on payment.
- XW0DXV5 – Introduction of Gilteritinib Antineoplastic into mouth and pharynx, external approach, new technology group 5
- JAKAFI™ (Ruxolitinib) JAKAFI™ is an oral kinase inhibitor that inhibits Janus-associated kinases 1 and 2 (JAK1/JAK2). The JAK pathway, which includes JAK1 and JAK2, is involved in the regulation of immune cell maturation and function. According to the applicant, JAK inhibition represents a novel therapeutic approach for the treatment of acute graft-versus-host disease (GVHD) in patients who have had an inadequate response to corticosteroids. The maximum payment a hospital can receive for this is $4,096.21. as a new technology add on payment.
- XW0DXT5 – Introduction of Ruxolitinib into mouth and pharynx, external approach, new technology group 5
- T2Bacteria® Panel (T2 Bacteria Test Panel) Is a lab test indicated as an aid in the diagnosis of bacteremia, bacterial presence in the blood which is a precursor for sepsis. The maximum payment a hospital can receive for this is $97.50 as a new technology add on payment.
- XXE5XM5 – Measurement, circulatory, external, infection, whole blood nucleic acid-base microbial detection, new technology group 5
- ContaCT (“Viz LVO”, “Viz View”) is a radiological computer-assisted triage and notification software system intended for use by hospital networks and trained clinicians. ContaCT analyzes computed tomography angiogram (CTA) images of the brain acquired in the acute setting, sends notifications to a neurovascular specialist(s) that a suspected large vessel occlusion (LVO) has been identified, and recommends review of those images. Helps to reduce the time to treat stoke patients. The maximum payment a hospital can receive for this is $1,040.00 as a new technology add on payment
- 4A03X5D – Measurement of Arterial Flow, Intracranial, External Approach
- Eluvia™ Drug-Eluting Vascular Stent System. Eluvia s a drug-eluting stent for the treatment of lesions in the femoropopliteal arteries. There are 16 dilation codes, X27—5 depending on which artery it is placed in and how many. The maximum payment a hospital can receive for this is $13,646.50 as a new technology add on payment.
- Hemospray® Endoscopic Hemostat is indicated by the FDA for hemostasis of nonvariceal gastrointestinal bleeding. Using an endoscope to access the gastrointestinal tract, the Hemospray delivery system is passed through the accessory channel of the endoscope and positioned just above the bleeding site without making contact with the GI tract wall. The Hemospray powder, bentonite, is propelled through the application catheter, either a 7 or 10 French polyethylene catheter, by release of CO2 from the cartridge located in the device handle and sprayed onto the bleeding site. The maximum payment a hospital can receive for this is $1,625.00 as a new technology add on payment.
- XW0G886 – Introduce Mineral Topic Hemostat in Up GI, Endo, New Tech 6
- XW0H886 – Introduce Mineral Topic Hemostat in Low GI, Endo, New Tech 6
- IMFINZI® (durvalumab) (AstraZeneca PLS) and TECENTRIQ® (atezolizumab) are indicated in treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or who have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum containing chemotherapy. Codes reporting dx code from category C34 with Z51.11 or Z51.12, Encounter for chemotherapy/immunotherapy with one of the below procedure codes. The maximum payment a hospital can receive for this is $6,875.90 as a new technology add on payment.
- XW03336 – Introduce Durvalumab in Peripheral Vein, Perc, New Tech 6
- XW04336 – Introduce Durvalumab in Central Vein, Perc, New Tech 6
- XW033D6 – Introduce Atezolizumab in Peripheral Vein, Perc, New Tech 6
- XW043D6 – Introduce Atezolizumab in Central Vein, Perc, New Tech 6
- Soliris ® is approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. The maximum payment a hospital can receive for this is $21,199.75 as a new technology add on payment.
- XW033C6 – Introduction of Eculizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 6
- XW043C6 – Introduction of Eculizumab into Central Vein, Percutaneous Approach, New Technology Group 6
- The SpineJack® System is an implantable fracture reduction system, which is indicated for use in the reduction of painful osteoporotic vertebral compression fractures (VCFs) and is intended to be used in combination with Stryker VertaPlex and VertaPlex High Viscosity (HV) bone cement. Implanted into a collapsed vertebral body (VB) via a percutaneous transpedicular approach under fluoroscopic guidance. The maximum payment a hospital can receive for this is $3,654.72 as a new technology add on payment.
- XNU0356 – Supplement Lumbar Vertebra w Mech Expnd Pair, Perc, New Tech 6
- XNU4356 – Supplement Thoracic Vertebra w Mech Expnd Pair, Perc, New Tech 6
- BAROSTIM NEO® System is indicated for the improvement of symptoms of heart failure – quality of life, six-minute hall walk and functional status – for patients who remain symptomatic despite treatment with guideline-directed medical therapy, are NYHA Class III or Class II (who had a recent history of Class III), have a left ventricular ejection fraction ≤ 35%, a NT-proBNP < 1600 pg/ml and excluding patients indicated for Cardiac Resynchronization Therapy (CRT) according to AHA/ACC/ESC guidelines. The maximum payment a hospital can receive for this is $22,750 as a new technology add on payment.
- 0JH60MZ – Insertion of Stimulator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach
- 03HK0MZ – Insertion of Stimulator Lead into Right Internal Carotid Artery, Open Approach
- 03HL0MZ – Insertion of Stimulator Lead into Left Internal Carotid Artery, Open Approach
- FETROJA® (A – Cefiderocol Anti-infective) is an injectable β-lactam antibiotic indicated for the treatment of complicated urinary tract infections (cUTI), including pyelonephritis, caused by the following susceptible Gram-negative (GN) pathogens: Escherichia coli (including with concurrent bacteremia), Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Citrobacter freundii, Enterobacter cloacae, Morganellamorganii, and Serratia marcescens. Cefiderocol should be used to treat infections where limited or no alternative treatment options are available and where cefiderocol is likely to be an appropriate treatment option, which may include use in patients with infections caused by documented or highly suspected carbapenem-resistant (CR) and/or multidrug-resistant GN pathogens. The maximum payment a hospital can receive for this is $7,919.86 as a new technology add on payment.
- XW033A66 – Introduce Cefiderocol Anti-infective in Peripheral Vein, Perc, New Tech 6
- XW043A66 – Introduce Cefiderocol Anti-infective in Central Vein, Perc, New Tech 6
- CONTEPO™ (fosfomycin for injection) (ZTI-01) intended for treatment of complicated urinary tract infections (cUTI) and is designated by FDA as a QIDP. The maximum payment a hospital can receive for this is $2,343.75 as a new technology add on payment.
- XW033K5 – Introduce Fosfomycin in Peripheral Vein, Perc, New Tech 5
- XW043K5 – Introduce Fosfomycin in Central Vein, Perc, New Tech 5
- NUZYRA® (omadacycline) for injection is a tetracycline class antibacterial indicated for the treatment of adult patients with the following infections caused by susceptible microorganisms: Community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI). A single-does vial containing 100 mg. The maximum payment a hospital can receive for this is $1,552.50 as a new technology add on payment.
- XW033B6 – Introduce Omadacycline in Peripheral Vein, Perc, New Tech 6
- XW043B6 – Introduce Omadacycline in Central Vein, Perc, New Tech 6
- RECARBRIO™ administered by intravenous infusion over 30 minutes as a fixed-dose combination of imipenem, a penem antibacterial; cilastatin, a renal dehydropeptidase inhibitor; and relebactam, a novel β-lactamase inhibitor (BLI). According to the applicant, RECARBRIO™ is intended for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) for patients 18 years of age and older. The maximum payment a hospital can receive for this is $3,532.78 as a new technology add on payment.
- XW033U5 – Introduce IMI/REL in Peripheral Vein, Perc, New Tech 5
- XW043U5 – Introduce IMI/REL in Central Vein, Perc, New Tech 5
- XENLETA (Lefamulin) a pleuromutilin antibacterial agent representing the first intravenous (IV) and oral treatment option from a novel class of antibiotics for community-acquired bacterial pneumonia (CABP). Can be given orally or by injection.. The maximum payment a hospital can receive for this is $1,275.75 as a new technology add on payment
- XW03366 – Introduce Lefamulin in Peripheral Vein, Perc, New Tech 6
- XW04366 – Introduce Lefamulin in Central Vein, Perc, New Tech 6
- XW0DX66 – Introduce Lefamulin in Mouth/Phar, Extern, New Tech 6
- ZERBAXA® (ceftolozane and tazobactam) is a combination of ceftolozane, a cephalosporin antibacterial; and tazobactam, a β-lactamase inhibitor (BLI), indicated in patients 18 years or older for the treatment of the following infections caused by designated susceptible microorganisms:
- Complicated Intra-abdominal Infections (cIAI), used in combination with metronidazole;
- Complicated Urinary Tract Infections (cUTI), Including Pyelonephritis;
- Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia (HABP/VABP)
The maximum payment a hospital can receive for this is $1,836.98 as a new technology add on payment.
- XW03396 – Introduce Ceftoloz/Tazobac in Peripheral Vein, Perc, New Tech 6
- XW04396 – Introduce Ceftoloz/Tazobac in Central Vein, Perc, New Tech 6
- Optimizer System: Intended for the treatment of chronic heart failure in patients with advanced symptoms that have normal QRS duration and are not indicated for cardiac resynchronization therapy. consists of three components. First, the Optimizer Rechargeable Implantable Pulse Generator (IPG) is designed for subcutaneous implant and delivers cardiac contractility modulation to the heart via two standard pacing leads attached to the right ventricular septum. Second, the Optimizer Mini Charger recharges the Optimizer IPG. Finally, the Omni II Programmer with Omni SMART Software gives a qualified healthcare professional the ability to program the Optimizer IPG over a large range of clinical settings. The maximum payment a hospital can receive for this is $14,950 as a new technology add on payment.
- 0JH60AZ, 0JH63AZ, 0JH80AZ or 0JH83AZ, Insert Contractility Modulation Device in Chest or Abdomen, Subcu/Fascia, Open or Percutaneous
- 02HK0MZ, 02HK3MZ, 02H60MZ, or 02H63MZ Insertion of Cardiac Lead into Right Ventricle or Right Atrium, Open Approach, or Percutaneous Approach
CMS Website Information on New Technology: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html
The information contained in this post 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 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.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.