CMS announces new ICD-10-PCS codes to capture COVID-19 therapeutics -- effective August 1

Update: On August 6, CMS added two files to the ICD-10-PCS COVID-19 update posted on July 30. They are: 1) the xml file icd10pcs_tables_2021.xml containing the combined complete FY 2021 update (the regular update posted in June plus the July 30 update for COVID-19 therapeutics), and 2) the combined complete FY 2021 tables addenda file tables_addenda_2021.pdf. Developers and other technical users will want to check out these files. The two additional files are included in the download posted at the same location as the original set of addenda files.

I spoke too soon when I said in a previous blog that there was nothing unusual about this year’s ICD-10-PCS update. It was not to be, not this year.

According to an announcement posted July 30 on the CMS website, “In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) is implementing 12 new procedure codes to describe the introduction or infusion of therapeutics, including remdesivir and convalescent plasma, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective August 01, 2020.”

In addition to ICD-10-PCS codes for remdesivir and convalescent plasma, two other named substances have their own PCS codes. Each of the four substances has two codes apiece, because each substance can be administered via central or peripheral IV infusion. The eight substance-specific codes are below.

Table XW0
Remdesivir (trade names Veklury and GS-5734)

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®)

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 (trade name ACTEMRA®)

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

Table XW1
Convalescent plasma (nonautologous)

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

In addition, non-specific PCS codes have been added to table XW0 to capture administration of COVID-19 therapeutics not classified elsewhere. The four codes capture therapeutics administered via central or peripheral IV infusion, subcutaneous injection or as an oral medication. As of this post, no specific substances have been designated for these codes. The four non-specific codes are listed below.

Table XW0
Other New Technology Therapeutic Substance

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 new ICD-10-PCS codes do not specify that they are for treatment of COVID-19, because diagnosis information is captured in the ICD-10-CM code. This is consistent with ICD-10 classification conventions.

The codes are in section X New Technology of the ICD-10-PCS tables because, as CMS has stated at previous ICD-10 Coordination and Maintenance (C&M) Committee meetings, two types of procedures are typically included in Section X: 1) procedures that are not usually assigned a code on an inpatient record, and 2) procedures that require a new code(s) to uniquely identify the procedure for CMS’ New Technology Add-on Payment (NTAP) program. The new PCS codes fall under the first category. The new codes are designated with the qualifier New Technology Group 5, rather than designated New Technology Group 6 along with the new FY 2021 PCS codes posted on the CMS website on May 28, because they are valid on August 1 and so are retroactively included in the FY 2020 update. The new codes and associated official ICD-10-PCS content are posted in a separate set of addenda files.

Also posted on the CMS website are the updated MS-DRGs and Medicare Code Editor (MCE) software that includes the new codes. The ICD-10 MS-DRG Grouper software is designated version 37.2. This version of the grouper and code editor will assign an MS-DRG and validate correct coding for discharges on or after August 01, 2020. The files include the ICD-10 MS-DRG V37.2 Grouper Software, Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V37.2 manual.

For MS-DRGs, the new codes are designated Non-OR and will not affect DRG assignment. However, they can be used for tracking clinical outcomes associated with these treatments, and so accurate code assignment has the potential to be very important. Hopefully this data will contribute to advances in further understanding of effective treatments to reduce the severity and duration of acute illness in this formidable new disease, as well as mitigating its longer-term effects.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.

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