Q: VitalWare is reporting that New Technology Add-on Payment for Abecma and Tecartus but they also drive to DRG 018. How does that work?
A: This is correct. CAR T-cell therapies are assigned to MS-DRG 018 through a pre-MDC. Abecma and Tecartus both also receive NTAPs as of October 1, 2021. CAR T-cell therapy is a new technology and in the final rule for FY 2021, CMS discussed that because there is no existing claims data for these procedures, it is too soon to create MS-DRG rates for them. This is subject to change as more claims data become available.
Q: Are the codes on slide 10 for MDC03, DRG switch from 140/141/142 to 143/144/145 correct? They are the same as DRG Change from 981/982/983 to 987/988/989 on slide 18. Plus, slide 9 is for Head and Neck procedures but the codes are for chest, back and abdomen.
A: The codes on slide 10 are correct, even though the procedures seem unrelated to the diagnoses of the ear, nose, mouth, and throat. CMS explained this in the Final Rule as: “In each MDC there is usually a medical and a surgical class referred to as ‘other medical diseases’ and ‘other surgical procedures,’ respectively… The ‘other’ surgical category contains surgical procedures which, while infrequent, are still reasonable expected to be performed for a patient in the particular MDC.”
When the principal diagnosis is for an ear, nose, mouth, and throat condition, these procedures now group to MS-DRGs 143-145 (non-extensive O.R. procedure) rather than MS-DRGs 140-142 (extensive O.R. procedure). When the principal diagnosis is not an ear, nose, mouth, or throat condition, as noted on slide 19, the codes will group to MS-DRGs 987-989 for non-extensive O.R. procedure unrelated to the principal diagnosis.
Q: Does the MaB new Dx codes for 2022 have NTAP payment
A: The NTAP application for TERLIVAZ/terlupressin/narsoplimab (XW03357, XW04357) was withdrawn by the manufacturer and thus not considered. RYBREVANT™/amivantamab (XW033B7, XW043B7) was approved for a NTAP as noted on slide 44 of the presentation.
Q: With the new unspecified code edit, can we use non-physician documentation to obtain documentation on laterality?
A: Yes. The ICD-10-CM Official Guidelines for Coding and Reporting have been changed for FY 2022 to state that documentation from clinicians other than the patient’s provider can be used to determine laterality. This guideline was updated to allow for more complete code capture and reduce reporting of unspecified codes.
Q: How long has the COVID public health emergency been extended for?
A: The public health emergency has been extended as of July 19, 2021. An end date was not included in the renewal. You can check for updates to all public health emergencies at https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx. How can we keep updated on additions to the NCTAP payments?
Q: How can we keep updated on additions to the NCTAP payments?
A: CMS has a webpage dedicated to New COVID-19 Therapy Add-on Payments. This webpage includes a list of NCTAPs and their eligibility dates: https://www.cms.gov/medicare/covid-19/new-covid-19-treatments-add-payment-nctap.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.