Summer Catchup with Adding and Updating HCPCS Codes

There are new CPT® codes effective July 1, 2023, which are published in MLN Matters 13210 dated June 13. There is a companion Change Request 13210 document which provides greater detail.

The new COVID vaccine and administration codes are 0174A for the administration of Pfizer-BioNTech COVID vaccine, Bivalent for patients six months through four years of age. The vaccine is CPT 91317.

There are 15 new CPT Proprietary Laboratory Analyses codes effective July 1. The change request document will provide a detailed list with long descriptors and status indicators. The new codes fall between 0387U through 0401U.

There are 20 new CPT Category III codes that were released in January but were effective July 1. CPT 0791T through 0810T are the codes that have been added. For example, 0793T has the description of percutaneous transcatheter thermal ablation of nerves enervating pulmonary arteries and includes right heart catheterization, pulmonary artery angiography, and all imaging guidance.

There are some new HCPCS procedure codes including the following:

• Endoscopic sleeve gastroplasty service – C9784 with status indicator of J1.

• Endoscopic outlet reduction service – C9785 with status indicator of J1.

• Diagnostic aid service for routine functional cardiovascular assessment using echocardiography – C9786 with status indicator of S.

• High resolution gastric electrophysiology mapping procedure – C9787 with status indicator of S

There are six new HCPCS codes for reporting drugs and biologicals with status indicator of G. For example, J1440 is new with the description of fecal microbiota, live-jslm, 1 ml.

There are three new HCPCS codes for high-cost skin substitute and 12 new HCPCS codes for low-cost skin substitutes.

If you collaborate with outpatient cases, perform charging, or are a chargemaster coordinator, it is imperative that you review MLN 13210 and/or Change Request 13210 for all the details.

The next Coordination and Maintenance Committee meeting will be held on Sept. 12 and 13. The tentative agendas have not been posted.

The National Center of Health Statistics (NCHS) released an erratum for FY24 ICD-10-CM on July 26 which corrected the Index entry for cachexia to R64. Dr. James Kennedy spoke about this issue during Talk Ten Tuesday, July 25.

Another inclusion in the errata was the correction of the spelling of thalassemia which is found in the inclusion terms for code H35.2 (Other non-diabetic proliferative retinopathy). A second update was made to this area with the correction of the code associated with the inclusion terms under category H35 (Disorders of endocrine glands in diseases classified elsewhere).

The diagnosis code associated with the inclusion term late congenital syphilis of thymus gland [Dubois disease] was corrected from A50.5 to A50.59.

Programming note: Listen to live coding reports by Laurie Johnson every Tuesday on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.

Resources:
MLN 13210
CR 13210
https://www.cms.gov/Medicare/Coding/ICD10/C-and-M-Meeting-Materials
https://www.cms.gov/medicare/icd-10/2024-icd-10-cm