Q:  You mentioned that Yescarta and Kymriah would group to the new MS-DRG 018 for CAR T-cell therapies.  There are 2 new codes for CAR T-cell therapies from the new technology section in 2021.  Will those codes also group to MS-DRG 018?

A:  Two new CAR T-cell therapies (brexucabtagene autoleucel [TECARTUS] and lisocabtagene maraleucel [liso-cel]immunotherapy) were given New Technology codes for FY 2021.  Both of those immunotherapies group to MS-DRG 018, Chimeric antigen receptor (CAR) T-cell immunotherapy.

Q:  For FY 2021, codes K20.81, K20.91, and K21.01 for esophagitis with bleeding are considered MCCs.  What documentation is necessary to be able to link these conditions with bleeding?

A:  Per ICD-10-CM coding convention I.A.15:

The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).

For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.

The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.

ICD-10-CM indexing makes an assumed link between unspecified esophagitis, other specified esophagitis, and GERD with esophagitis and bleeding.  As such, the provider does not need to document the link between the two conditions to use the combination code.

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

Kristi is a senior consultant with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.

Kristi has served the Colorado Health Information Management Association (CHIMA) as board Director, co-chair of the Data Quality Committee, and co-chair for the ICD-10 Task Force. She is also a past president of the Northern Colorado Health Information Management Association (NCHIMA). Kristi is the proud recipient of the 2011 AHIMA Triumph Award for Mentoring for her voluntary work as the “Coder Coach.” She has also received awards from CHIMA for Distinguished Member (2018) and Outstanding Volunteer (2013) and from AHIMA for Roundtable Achievement in Coding Excellence (RACE).

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