CMS Announced New Hospital Procedure Codes for Therapeutics

CMS Announced New Hospital Procedure Codes for Therapeutics

The emergence of coronavirus disease 2019 (COVID19) and the new treatments that have followed, to track the use of treatments is critical and their effectiveness is real time. The CMS responded this need, and in record time is implementing new procedure codes to allow Medicare and other insurers to identify the use of the therapeutics remdesivir and convalescent plasma for treating hospital in-patients with COVID-19. These new codes will be effective from August 1, and these will enable CMS to conduct real-time surveillance and obtain real-world evidence in how these drugs are working and provide critical information on their usefulness and how they can protect patients. These new codes are helpful to report to Medicare and other insurers may also use the codes to identify the use of COVID19 therapies. This also help to facilitate monitoring and data collection on their use.

These new codes are being implemented into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). ICD-10-PCS is the Health Insurance Portability and Accountability Act (HIPAA) designated code set for reporting hospital inpatient procedures, which is developed and maintained by CMS and can be used by other health insurers.

The implementation of these new procedure codes is part of the Trump Administration’s ongoing efforts to protect the health and safety of COVID-19 patients across the country during the public health emergency.

The ICD-10 MS-DRG Grouper software package to accommodate these new codes, Version 37.2, is effective for discharges on or after August 01, 2020. As indicated in the table below, these codes will not affect the MS-DRG assignment.

Assignment of the new ICD-10-PCS procedure codes is as follows:

Procedure Code XW013F5

Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5.

Procedure Code XW033E5

Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW033F5

Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW033G5

Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW033H5

Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW043E5

Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW043F5

Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW043G5

Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW043H5

Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW0DXF5

Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5

Procedure Code XW13325

Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5

Procedure Code XW14325

Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5

As the procedure codes are designated as non-O.R. procedures, there is no assigned MDC or MS-DRG. The ICD-10 MS-DRG assignment is dependent on the reported principal diagnosis, any secondary diagnoses defined as a complication or comorbidity (CC) or major complication or comorbidity (MCC), procedures or services performed, age, sex, and discharge status.

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Get more information at:

The ICD-10 MS-DRG V37.2 Grouper Software, Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V37.2 manual

The Code Tables, Index and related Addenda files for the 12 new procedure codes

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