Procedural coding has some notable changes in 2019.
Question: What are highlights of the ICD-10 FY19 changes?
Answer: Some of the most notable coding updates for FY19 were in the ICD-10-PCS procedure section. Please pay close attention to the following new technologies and other treatments as they can impact healthcare provider payments going forward.
Irreversible Electroporation (IRE). This is a new technology used for treatment of unresectable pancreatic cancer using non-thermal ablation. The tumor is ablated using small high-voltage pulses that induce slow cell death over time. The advantages of this type of ablation are it is very tissue selective, only destroying the cancer cells and preserving the vital structures that surround the tumor, and it is also very quick. A typical treatment takes less than 5 minutes, not including the electrode placement. One final advantage is that this procedure can be monitored in real time and can be visualized both during and after the treatment. IRE is used as a qualifier in a PCS code under Root Operation ‘Destruction,’ Body Part ‘Pancreas.’
Robotic Waterjet Ablation. This is also known in the industry as “Aquablation” or “Aquabeam System.” This technology is used to treat Benign Prostatic Hypertrophy (BPH). This method is heat-free and uses a high-velocity waterjet to resect prostate tissue. This procedure is typically done as an outpatient and uses CPT code 0421T for payment. However, if you have the occasion to code this on an inpatient record, you will find this code under the “New Technology” section in ICD-10-PCS under “Destruction, Prostate, Robotic Waterjet Ablation” (XV508A4).
Injection of Plazomicin. Although only an injection, Plazomicin (ZEMDRI) was fast-tracked by the FDA in 2012 because it does such a good job at treating serious bacterial infections. In particular, it is shown to be effective for those patients who have been unresponsive to other treatments. Don’t forget to code this injection, as Medicare will pay for up to 50 percent of the cost of ZEMDRI, up to $2,722 per patient in addition to the MS-DRG payment.
Injection of Synthetic Human Angiotensin II. Another injection, Synthetic Human Angiotensin II (Giapreza), is used to increase blood pressure in adults with septic (or other) shock. The response time for this injection is very quick—approximately 5 minutes. Again, this add-on payment is one that you don’t want to miss as it is paid at up to $1,500 per qualifying case.
Extracorporeal membrane oxygenation (ECMO). Because peripheral extracorporeal membrane oxygenation (ECMO) does not require a sternotomy and can be done at bedside, the Centers for Medicare & Medicaid Services (CMS) has shifted this to a different MS-DRG. All ECMO currently fall under MS-DRG 003 – ECMO or Trach w/MV > 96 hours or PDX except face, mouth, and neck w/major OR (RW= 18.2974). In FY19, peripheral ECMO will be identified as a “non-OR procedure” that will affect MS-DRG assignment. This will result in a significant decrease in the relative weight and payment of peripheral ECMO moving forward. The FY19 peripheral ECMO MS-DRGs include the following:
- 207 – Respiratory System Diagnosis with Ventilator Support 96 Hours or Peripheral Extracorporeal Membrane Oxygenation (ECMO) (RW= 5.5965)
- 291 – Heart Failure and Shock with MCC or Peripheral Extracorporeal Membrane Oxygenation (ECMO) (RW= 1.3454)
- 296 – Cardiac Arrest, Unexplained with MCC or Peripheral Extracorporeal Membrane Oxygenation (ECMO) (RW= 1.5355)
- 870 – Septicemia or Severe Sepsis with MV96 Hours or Peripheral Extracorporeal Membrane Oxygenation (ECMO) (RW= 6.2953)
