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Q:  When should the new qualifier M for Monoclonal Antibody in the 3E0 table be used? Can it be used to report cancer or COVID MAB therapy?
A:  The qualifier M for Monoclonal Antibody is only available when the 6th character substance value C, Other Therapeutic Substance, is selected. When a monoclonal antibody (MAB) is administered to treat cancer, the 6th character substance value is 0, Antineoplastic, and the qualifier is M, Monoclonal Antibody. MAB therapy for COVID-19 is still reported with codes from the New Technology section. Below is an excerpt from table 3E0 showing the substance and qualifier values for MAB therapy for cancer versus other non-COVID conditions. (Source: Coordination and Maintenance Meeting Topic notes from March 8, 2022, page 32).

Q:  With the removal of these codes from the New Technology section, are there any devices in the 0RG and 0SG fusion tables to differentiate nanotextured and radiolucent devices?
A:  No, the ICD-10-PCS code set will no longer differentiate between nanotextured or radiolucent devices. The device value A, Interbody Fusion Device, is used to report all interbody fusion devices used for spinal fusion in the 0RG and 0SG tables.

Q:  Does the placement of this device include facetectomy and laminectomy, or are those procedures coded separately?
A:  Since facetectomy or laminectomy may be performed before the placement of the TOPS device to decompress the spinal cord or nerves, an additional code may be reported for decompressive procedures. When a procedure, such as facetectomy or laminectomy is done for decompression of the spinal canal or nerves, the root operation is Release and the body part is the structure being released, such as a spinal nerve.

9/22/22 Q:  I was updating my NTAP tracking list of drugs that are being discontinued based on the presentation but see that the drug Fetroja(Cefiderocol) is on both the discontinued and the continuing NTAP list. This may be due to the fact that there is a difference in the drug for this FY?
A:  Fetroja® is included on both lists; the difference is the indication for the drug. Its use as a treatment for complicated UTI (cUTI) is being discontinued for FY 2023. However, when used to treat hospital-acquired bacterial pneumonia (HABP) or ventilator-associated bacterial pneumonia (VABP), the NTAP status is being continued.

Table II.F.-01 from the Final Rule includes NTAPs that are being continued. Note that the PCS codes listed for Fetroja® will pay the NTAP for code Y95 (nosocomial infection) in combination with an HABP/VAPB diagnosis:

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 20 years of industry experience. She develops and delivers training on ICD-10-CM/PCS and CPT, both virtually and in classroom settings.
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.


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