Christmas in July with the Gift of New ICD-10-PCS Codes

New PCS codes were released late last week and are effective Aug. 1, 2020. The codes are considered V37.2. There are 12 new procedure codes, and they are related to COVID-19.

The good news is that these procedure codes are not designated as DRG OR procedures, so they do not affect the MS-DRG assignment. They can all be found in the New Technology section and Anatomic Region body system of ICD-10-PCS. Six new procedures incorporate three new substances related to treating COVID-19: Remdesivir Anti-Infective, Sarilumab, and Tocilizumab.

There have been studies regarding Remdesivir’s effectiveness in treating COVID-19. The early results show that this drug has shortened patients’ recovery time. Sarilumab is also known as Kevzara, and is used to treat rheumatoid arthritis. The clinical trials related to this drug have been stopped due to disappointing results. Tocilizumab is another drug that is used to treat rheumatoid arthritis, as well as cytokine release syndrome. The initial results of the clinical trials are promising in reducing the risk of invasive mechanical ventilation for patients who have pneumonia with COVID-19.

The approach for these substances is percutaneous, and includes body parts of central and peripheral vein. The root operation is Introduction and the Qualifier is New Technology Group 5, which indicates the 2020 fiscal year.

Two new codes are for the transfusion of convalescent plasma, non-autologous. This substance is found in patients who have recovered from COVID-19 and have antibodies for the disease. The plasma is separated from the blood of a recovered patient who has not had any COVID-19 symptoms for at least 14 days. The convalescent plasma is then transfused into a COVID-19 patient. This treatment is still in clinical trials, without any posted results.

These new codes use the root operation of Transfusion in the New Technology Section. The Approach is percutaneous, with Body Parts of central and peripheral vein. The Qualifier is New Technology Group 5.

Another new development in this release of new PCS codes is the creation of codes for the substance of “Other New Technology Therapeutic Substance.” It is thought that this alternative could be used for new substances that do not have an appropriate other alternative. The approaches include percutaneous and external. The body parts are central vein, peripheral vein, mouth, and pharynx, along with subcutaneous tissue. The Qualifier is New Technology Group 5.

These new codes were effective Aug. 1, 2020, but encoder companies are busy trying to update their encoder software. While you are waiting for the update, please prepare for these new codes. Here are some action items:

1. 1. Does your facility use any of these substances?
   2. Do you have other ways to identify patients who are given these substances? Remember that these substances will have HCPCPS codes to capture the charges.
   3. Will anyone use the data if you take the time to code it?
   4. Determine how you want to use the Other New Technology Therapeutic Substance codes, and provide instructions to the coders.
   5. Add any information to your new version of facility-specific coding guidelines.

This late release of new procedure codes is unprecedented, but we are not usually immersed in a pandemic. Take some time to determine how you want the information to be used. Involve other people at your facility before you make decisions on how to utilize these new codes. Remember that the codes do not affect MS-DRG assignment, so there is no rush.

Think of the release of these new codes as Christmas in July: the gift of new PCS codes.

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Programming Note:
Laurie Johnson is a permanent panelist on Talk Ten Tuesdays. Listen to her coding report during Talk Ten Tuesdays, 10-10:30 a.m. EST.