This page addresses follow-up questions and additional information pertinent to our webinar
IPPS Final Rule & MS-DRG Updates FY 2027: What Every Coder Needs to Know.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
A: The maximum New Technology Add-on Payment (NTAP) for ZEVTERA® varies based on the indication for which the drug is used. For FY 2027, ZEVTERA® has a maximum NTAP of $5,287.50 when used to treat acute bacterial skin and skin structure infections (ABSSSI) or community-acquired bacterial pneumonia (CABP), compared with $16,215 when used to treat Staphylococcus aureus bloodstream infections (SAB).
The higher maximum NTAP for SAB reflects the greater amount of ZEVTERA® required for the treatment regimen, resulting in a higher technology cost.
From a coding perspective, the same ICD-10-PCS codes identify the administration of ZEVTERA® for these indications. Therefore, the diagnosis coding is important in determining the indication being treated and the applicable maximum NTAP amount.
A: Although the Spur® Peripheral Retrievable Stent System includes a self-expanding stent, the stent is not permanently implanted. During treatment, the Spur® stent is temporarily deployed within an infrapopliteal artery to provide mechanical scaffolding and create controlled channels in the vessel wall. The device is then collapsed and retrieved at the end of the procedure, leaving no permanent implant behind.
For FY 2027, cases eligible for the Spur® New Technology Add-on Payment (NTAP) are identified by one of six ICD-10-PCS New Technology Group 11 codes: X2HP38B, X2HQ38B, X2HR38B, X2HS38B, X2HT38B, or X2HU38B. These codes use device value 8, Intraluminal Device, Temporary, and distinguish the applicable infrapopliteal artery and laterality.
This distinction is particularly important for FY 2027 because new codes in ICD-10-PCS table X27 use device value N, Intraluminal Device(s), Small-diameter. These codes describe a small-diameter intraluminal device that remains implanted and do not identify Spur® for purposes of the FY 2027 NTAP.
Key takeaway: The key coding takeaway is that the word “stent” does not automatically mean a permanent implant. For Spur®, the temporary nature of the device is essential to selecting the appropriate ICD-10-PCS code and identifying cases eligible for NTAP.
A: Table 10.1 of the IPPS FY 2027 Final Rule contains 174 qualifying fusion codes. The Ceribell Delirium Exclusion Diagnosis list is in Table 10.2. Click here to find both tables on CMS’ website
A: Table 5 of the IPPS FY 2027 Final Rule includes all MS-DRGs for GROUPER V44.0, which can be downloaded here from the CMS website
A: The MS-DRG v44.0 Definitions Manual can be accessed at: ICD-10-CM/PCS MS-DRG v44.0 Definitions Manual
Meet the Presenter: Kristi Pollard, RHIT, CCS, CPC, CIRCC
Kristi is the Director of Coding Quality & Education 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.
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