Part 4: New ICD-10 Codes and IPPS Changes

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

New Technology Add-On Payments (NTAP) FY2020

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 FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.

Section “X” New Technology

CMS provides incremental payment (in addition to the DRG payment) for technologies that qualify for NTAP.  FY2020 65% up from 50%. The agency finalized a 75% new technology add-on payment for certain antimicrobials.

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 or letter 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 FY2019 will have the qualifier/seventh character of “4” since this is the third year of ICD-10-PCS.

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.

CMS Website Information on New Technology:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html

EVERY CODE COUNTS!

New Technology Procedure Codes and Reimbursement for FY2020

Below are the codes that will be reimbursed as NTAP codes. You may want to print this out and keep it handy or on your desktop for future reference.

1. YESCARTA™ (Axicabtagene Ciloleucel)
and KYMRIAH™ (Tisagenlecleucel).  (Fights non-Hodgkin’s Lymphoma and Acute Lymphoblastic Leukemia) For these CAR T-Cell therapies, the cost is $373,000. The maximum payment a hospital can receive for this is $242,450 as a new technology add on payment.

• XW033C3 – Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy intoperipheral vein, percutaneous approach, new technology group 3
• XW043C3 – Introduction of engineered autologous chimeric antigen receptor t-cell immunotherapy intocentral vein, percutaneous approach, new technology group  3

2. VYXEOS™ intravenous for treatment of adults with newly diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC). The maximum payment a hospital can receive for this is $47,352.50 as a new technology add on payment.

• XW033B3 – Introduction of Cytarabine and Daunorubicin Liposome Antineoplastic into peripheral vein, percutaneous approach, new technology group 3
• XW043B3 – Introduction of Cytarabine and Daunorubicin Liposome Antineoplastic into central vein, percutaneous approach, new technology group 3

3. Remedē® System by Respicardia, Inc. is indicated for use as a transvenous phrenic nerve stimulator in the treatment of adult patients who have been diagnosed with moderate to severe central sleep apnea (CSA). The Remedē® System consists of an implantable pulse generator, and a stimulation and sensing lead. The pulse generator is placed under the skin, in either the right or left side of the chest, and it functions to monitor the patient’s respiratory signals. A transvenous lead for unilateral stimulation of the phrenic nerve is placed either in the left pericardiophrenic vein or the right brachiocephalic vein, and a second lead to sense respiration is placed in the azygos vein. Both leads, in combination with the pulse generator, function to sense respiration and, when appropriate, generate an electrical stimulation to the left or right phrenic nerve to restore regular breathing pattern The maximum payment a hospital can receive for this is $22,425 as a new technology add on payment.

• 0JH60DZ – Insertion of Stimulator, Generator, Multiple Array into Subcutaneous Tissue, open approach
  AND
• 05H3/43MZ – Insertion of neurostimulator lead into right/left innominate vein, percutaneous
  WITH
• 05H03MZ – Insertion of neurostimulator lead into AZYGOS vein, percutaneous
  OR
• 05H04MZ – Insertion of neurostimulator lead into AZYGOS vein, percutaneous, endoscopic

4. 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

5. GIAPREZA™ a synthetic human angiotensin II, is administered through IV infusion to raise blood pressure in adult patients who have been diagnosed with septic or other distributive shock.  The maximum payment a hospital can receive for this is $4,083.75 as a new technology add on payment.

• XW033H4 – Introduction of Synthetic Human Angiotensin II into peripheral vein, percutaneous, new technology group 4
• XW043H4 – Introduction of Synthetic Human Angiotensin II into central vein, percutaneous, new technology group 4

6. Cerebral Protection System (Sentinel® Cerebral Protection System). indicated for the use as an embolic protection (EP) device to capture and remove thrombus and debris while performing transcatheter aortic valve replacement (TAVR) procedures for aortic stenosis. Cases involving the use of the Sentinel® Cerebral Protection System that are eligible for new technology add-on payments will be identified by ICD–10–PCS procedure.  The maximum payment a hospital can receive for this is $1,820 as a new technology add on payment.

• X2A5312 – Assistance via Innominate Artery and Left Common Carotid artery, percutaneous, Cerebral Embolic Filtration, Dual Filter, new technology group 2

7. VABOMERE™ (meropenem-vaborbactam) IV for adults with complicated UTIs and acute pyelonephritis (chills, rigors, temp higher than 38C, WBC over 10,000, etc.).  The maximum payment a hospital can receive for this is $7,207.20 as a new technology add on payment.

• XW033N5 – Introduction of Meropenem-vaborbactam Anti-infective into peripheral vein, percutaneous, new technology group 5
• XW043N5 – Introduction of Meropenem-vaborbactam Anti-infective into central vein, percutaneous, new technology group 5

8. AQUABEAM System (Aquablation) is indicated for the use in the treatment of patients experiencing lower urinary tract symptoms caused by a diagnosis of benign prostatic hyperplasia (BPH). The AQUABEAM System consists of three main components: a console with two high-pressure pumps, a conformal surgical planning unit with transrectal ultrasound imaging, and a single-use robotic hand-piece. would be assigned. The maximum payment a hospital can receive for this is $1,625 as a new technology add on payment.

• XV508A4 – Destruction of prostate using robotic waterjet ablation, via natural or artificial opening endoscopic, new technology group 4

9. AndexXa™ (Andexanet alfa) 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

10. 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 as a new technology add on payment.

• XW033S5 – Introduction of Iobenguane I-131 Antineoplastic into peripheral vein, percutaneous, new technology group 5
• XW043S5 – – Introduction of Iobenguane I-131 Antineoplastic into central vein, percutaneous, new technology group 5

11. 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 as a new technology add on payment.

• XW013W5 – Introduction of Caplacizumab into subcutaneous tissue, percutaneous, new technology group 5
• XW033W5 – Introduction of Caplacizumab into peripheral vein, percutaneous, new technology group 5
• XW043W5 – Introduction of Caplacizumab into central vein, percutaneous, new technology group 5

12. ELZONRIS™ 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 – Introduction of Tagraxofusp-erzs Antineoplastic into peripheral vein, percutaneous, new technology group 5
• XW043Q5 – Introduction of Tagraxofusp-erzs Antineoplastic into central vein, percutaneous, new technology group 5

13. 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

14. ERLEADA™ (Apalutamide).  This oral drug is an androgen receptor inhibitor indicated for the treatment of patients who have been diagnosed with non-metastatic castration-resistant prostate cancer (nmCRPC).  The maximum payment a hospital can receive for this is $1,858.25 as a new technology add on payment.

• XW0DXJ5- Introduction of Apalutamide Antineoplastic into mouth and pharynx, external, new technology group 5

15. 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

16. 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

17. AKAFI™ (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 $3,977.06. as a new technology add on payment.

• XW0DXT5 – Introduction of Ruxolitinib into mouth and pharynx, external approach, new technology group 5

18. 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

Happy Coding!

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.