New Codes Pose Potential Hazards for Coders

New ICD-10-CM/PCS codes, revealed in the 2023 Inpatient Prospective Payment System, will be analyzed during an upcoming IPPS coding summit.

No, it’s not business as usual when it comes to the recent posting of the 2023 Inpatient Prospective Payment System (IPPS) Final Rule released by the Centers for Medicare & Medicaid Services—new codes, deleted codes and code changes all pose challenges to new and veteran coders.

Coding: A Profession, not a Job

“Many coders see coding as a profession, not a job,” Laurie Johnson told ICD10monitor in a telephone conversation. Johnson, a veteran health information management (HIM) authority, will lead a three-day IPPS coding summit taking place Tuesday, Aug. 16, continuing through Thursday, Aug. 17. Johnson will be joined by Erica Remer, MD, founder of Erica Remer MD, and cohost on Talk Ten Tuesdays.

“They (coders) take pride in selecting the right code and often times will continue to ponder if they did, in fact, select the proper code,” Johnson continued.

Johnson said the professional coders are conscientious and will view preparation as an essential learning tool, noting that they take pride in their status as a professional coder, especially during the inevitable coding reviews.

New Codes, New Issues

According to Johnson there are a number of changes in the codes as described in the 2023 IPPS. Some of these changes, could inadvertently, contribute to a cascading effect on code selection.

“CMS is entertaining using the National Drug Codes (NDC) in place of PCS codes to trigger the New Technology Add-On Payment (NTAP),” said Johnson. “The use of the NDC codes in place of PCS codes will remove the need to get a PCS code for new technology add-on payments (NTAPs). This action will also impact the Coordination and Maintenance Committee meeting agenda.”

In recent years, the PCS agenda has been filled with administration of new medications and devices.  Typically, coders would not assign codes for the administration of specific medications or devices used during a procedure.  

Another area that will likely cause consternation is the Medicare Code Editor (MCE).

“I will review during the 2023 IPPS Coding Summit, MCE Edit #20 (Unspecified Codes) which became effective April 1, 2022.  This edit looks for unspecified laterality for ICD-10-CM codes and is triggered when the laterality is unspecified,” Johnson explained.  When the edit is triggered, there is a specific response if the code cannot be updated to a specified laterality.”  

Johnson said she will also report on the number of changes in the NTAP methodology.

“CMS has discontinued the NTAPs that were continued (for) an additional year due to the pandemic,” Johnson said.  “There are some new devices/medications to be added to the NTAPs. The discontinued items are due to aging out of the NTAP criteria. You don’t want to leave any money on the table by missing NTAPs.”

2023 IPPS Coding Summit

The 2023 IPPS Coding Summit, produced by ICD10monitor, kicks off today (Tuesday) and continues through Thursday. This is the third year that the event has been staged with the goal of providing education on the new codes.

“The consequence for using the wrong codes comes with the potential of losing revenue for your organization, denied claims and worse, losing budgetary funds for the imperative staff and team members,” said Angela Kornegor, chief operating officer for MedLearn Media Publishing, the parent company of RACmonitor and ICD10monitor. “Never before has mastering the use of reporting correct codes been as important as it is today,” Kornegor concluded.

Program Schedule

2023 IPPS Summit Day 1: Master ICD-10-CM Changes

This first session in our 2023 IPPS Summit will feature a review of FY 2023 changes to ICD-10-CM codes, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts.

2023 IPPS Summit Day 2: Master ICD-10-PCS Changes

This second session in our 2023 IPPS Summit will feature a review of the hundreds of FY 2023 changes to ICD-10-PCS codes, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts.

2023 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

This third session in our 2023 IPPS Summit will feature a review of FY23 changes to the MS-DRG methodology and NTAPs, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts.

The event will be available as a live presentation and an on-demand version will also be available. Additional information, including registration is here.