ICD-10 C&M Meeting: Understanding the Spirit of the Code

Amid confusion over New Technology codes, much attention was focused on partial knee joint replacements during the recent ICD-10 Coordination and Maintenance Committee meeting, March 8 and 9 at CMS headquarters.

The Coordination and Maintenance (C&M) Committee meeting was held March 6 and 7 to discuss potential new codes. The webcasts are posted online for viewing, if you missed it. Our work is not over in this matter. Now is the time for all code users to comment on the proposals.

For ICD-10-CM, the comments are due by May 11, 2018. Please note that the diagnosis codes discussed will not be implemented until Oct. 1, 2019, if accepted. Comments should be sent to nchsicd10CM@cdc.gov.   

For ICD-10-PCS, the comments are due by April 6, 2018. The procedure codes discussed will be implemented Oct. 1, 2018, if accepted. All of the materials and the handouts can be found online at https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html.

The procedure comments should be emailed to ICDProcedureCodeRequest@cms.hhs.gov. The final diagnosis and procedure code updates for 2019 (i.e., effective Oct. 1, 2018) will be published in June 2018.   

The next C&M meeting will be held Sept. 11 and 12, 2018. Registration for those who want to attend in person can be found at http://www.cms.hhs.gov/apps/events/ approximately one month prior.

There is always something new to learn when attending or watching the C&M meeting. Involvement provides the “spirit” of the codes. The background for each code request is explained. 

This year, there were requests for codes in the New Technology section, but the vendors had not applied for the New Technology Add-On Payment (NTAP) under the Inpatient Prospective Payment System (IPPS). This situation has led to confusion over the purpose of Section X in ICD-10-PCS. The original purpose of New Technology section was to identify those procedures that qualified for NTAP. Another issue that was introduced this year was confusion regarding the retirement of the New Technology codes.  

The New Technology section was created for ICD-10-PCS codes that had NTAP status, which is granted for two to three years. For 2019, the New Technology qualifier would be New Technology Group 4, which would indicate that New Technology Group 1 would be retired. That action was not discussed at this meeting.

One procedure that generated a lot of discussion was the insertion of the Remede Phrenic Nerve Stimulation System. This procedure is used to treat severe central sleep apnea in adults. There was a debate regarding the need to develop a specific code for phrenic nerve stimulation generation, and the talks expanded to touch on the need to develop codes for specific devices in general. The possibility of rapidly adding procedure codes exists when new codes are added based on very specific devices. The Centers for Medicare & Medicaid Services (CMS) requested input from the audience regarding this topic. 

Another area that attracted attention was a presentation on partial knee joint replacements. Hip and knee arthroplasties are among the most common inpatient procedures performed in the U.S. The request to add and/or revise devices under Replacement in the Lower Joints section include unicondylar (lateral and medial); synthetic substitute; patellofemoral; and articulating spacer. Modular head device was requested to be added to the Supplement root operation under the Lower Joints section.  

In summary, there were many proposals for new diagnosis and procedure codes made during the C&M meeting. More information will be provided over the coming weeks.

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