Last week, the Centers for Medicare and Medicaid Services (CMS) released 12 new ICD-10-PCS codes to report the administration of therapeutic substances in the treatment of COVID-19. All these codes are in the New Technology (X) section and allow for reporting of four specific and one nonspecific substance:
- Remdesivir
- Sarilumab (KEVZARA®)
- Tocilizumab
- Other new technology therapeutic substance
- Convalescent plasma transfusion
Remdesivir is a direct acting antiviral drug that inhibits viral RNA synthesis. It is investigational and not currently approved for a specific indication. A recent study suggested that COVID patients had a shortened recovery period, from 15 days to 11 days, when given this medication. As a result, this drug has been granted an emergency use authorization (EUA) from the Food and Drug Administration (FDA), allowing it to be used outside of clinical trials.
| XW033E5 | Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
| XW043E5 | Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5 |
Sarilumab (trade name KEVZARA®) is a human monoclonal antibody used to treat rheumatoid arthritis. Early studies suggest that it may be useful in controlling the inflammatory response in the lungs of patients who are severely or critically ill with COVID-19, although later studies have not shown it to be as effective as originally thought. Interleukin-I (IL-6) is a chemical that is activated by inflammation. Studies suggest IL-6 may play a key role in the inflammatory response in COVID patients with acute respiratory distress syndrome (ARDS). Sarilumab works by inhibiting the IL-6 pathway by binding and blocking the IL-6 receptor.
| XW033G5 | Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
| XW043G5 | Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5 |
Tocilizumab is another IL-6 inhibitor, conventionally used to treat rheumatoid arthritis. It is thought that the use of tocilizumab can result in improved oxygenation and other clinical outcomes.
| XW033H5 | Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
| XW043H5 | Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5 |
CMS left the door open for other therapeutic substances that may prove useful in the treatment of COVID-19 by creating four additional codes for other specified substances.
| XW013F5 | Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5 |
| XW033F5 | Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
| XW043F5 | Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5 |
| XW0DXF5 | Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5 |
The last substance that is believed to have some treatment value for COVID patients is convalescent plasma therapy. This is a transfusion of blood plasma from donors who have recovered from COVID-19. People who have recovered from COVID have antibodies that can activate the immune system to fight the virus. If you or someone you know have recovered from COVID, the FDA is asking for plasma donations.
| XW13325 | Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5 |
| XW14325 | Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5 |
While these 12 new codes have been added to version 37.2 of the Grouper for FY 2020 (effective 8/1/20), none of them have an impact on MS-DRG assignment or reimbursement. Even so, reporting these codes when applicable can help provide additional data on the usefulness of these therapies as health care officials navigate through the pandemic.
References
- Beigel, John H., et al. “Remdesivir for the Treatment of Covid-19 - Preliminary Report: NEJM.” New England Journal of Medicine, New England Journal of Medicine, 27 May 2020, www.nejm.org/doi/full/10.1056/NEJMoa2007764.
- Calabrese, Cassandra. “Sarilumab Enters Clinical Trial for COVID-19, Spotlighting 'Key Role' for IL-6.” Healio, 19 Mar. 2020, www.healio.com/news/rheumatology/20200319/sarilumab-enters-clinical-trial-for-covid19-spotlighting-key-role-for-il6.
- Hinton, RADM Denise M. “FDA Response to Request to Issue an EUA for Emergency Use of Remdesivir for the Treatment of Hospitalized 2019 Coronavirus Disease (COVID-19).” Received by Ashley Rhoades, MBS, RAC, Food and Drug Administration, 1 May 2020, www.fda.gov/media/137564/download#:~:text=This%20letter%20is%20in%20response,section%20II)%20of%20this%20letter%2C.
- “Sanofi and Regeneron's Kevzara Fails in Phase III Covid-19 Trial.” Clinical Trials Arena, 3 July 2020, www.clinicaltrialsarena.com/news/kevzara-us-covid19-trial-data/.
- Xu, Xiaoling, et al. “Effective Treatment of Severe COVID-19 Patients with Tocilizumab.” Edited by Zhu Chen, PNAS, National Academy of Sciences, 19 May 2020, www.pnas.org/content/117/20/10970.
Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Consultant
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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