Updated on: May 27, 2021

Proposed IPPS Rule Includes Criteria for Newness  

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Original story posted on: May 24, 2021

New substances and devices are cited in technology proposals.

The Inpatient Prospective Payment System (IPPS) Proposed Rule for the 2022 fiscal year (FY), which was released on April 27, includes numerous applications for New Technology Add-On Payments (NTAPs). The proposals will be finalized in the IPPS Final Rule, which should be published in early August 2021.

There is an unprecedented proposal to continue 15 items from FY 2021 that were due to be discontinued, based on the “newness” criteria. This proposal can be attributed to the COVID-19 pandemic. The items proposed to be continued include the following:

  • ZEMDRI
  • AndexXa
  • AZEDRA
  • Cablivi
  • ELZONRIS
  • SPRAVATO
  • T2 Bacterial Panel
  • ContaCT
  • Eluvia Drug Eluting Vascular Stent System
  • NUZYRA
  • Hemospray Endoscopy Hemostat
  • IMFINZI/TECENTRIQ
  • Spine Jack System Expansion Kit
  • XOSPATA

There are two items that are continued from FY 2020; they are JAKAFI, which treats graft versus host disease, and Balversa, which treats locally advanced or metastatic urothelial carcinoma. There are seven items that were continued from FY 2021; these items include the following:

  • BAROSTIM NEO System
  • Optimizer System
  • Cefiderocol
  • Soliris
  • RECARBRIO
  • XENLETA
  • ZERBAXA

There were several new proposals outlined in the proposed rule. The following items are among the new proposals – to be considered if they meet the “newness” criteria, the MS-DRG payment does not cover the cost, and they significantly impact patient outcomes.

Item

Treatment Of

Aidoc Briefcase

Pulmonary embolism

Amivantamab

Metastatic non-small cell lung carcinoma

Breyanzi

Relapsed/refractory large B-cell lymphoma

Ciltacabtagene autoleucel

Multiple myeloma

COSELA

Extensive-stage small cell lung carcinoma

Ellipsys Vascular Access System

End-stage renal disease

ENSPRYNG

Neuromyelitis optica spectrum disorder

ABECMA

Relapsed/refractory multiple myeloma

INDIGO Aspiration System with Lightning Aspiration Tubing

Pulmonary embolism, deep vein thrombosis, arterial thromboembolus

Ischemia Care Respiratory and Stroke Test Kit

Cardioembolic stroke and large artery atherosclerotic stroke

Lifileucel

Metastatic melanoma

Narsoplimab

Transplant-associated thrombotic microangiopathy

NexoBrid

Eschar (non-surgical option)

Olumiant

COVID-19

Pure-Vu Cleansing System

High-intensity, intra-procedural cleansing during colonoscopy

RAPID Aspects

Computer-aided software device used to detect abnormal brain tissue

Steripath Micro Blood Collection System

Single-use collection device for blood cultures

StrataGraft Skin Tissue

Severe thermal burns

Tecartus

Relapsed/refractory mantle cell lymphoma

Terlivaz

Hepatorenal Syndrome, Type 1

Veklury

COVID-19

ZEPZELCA

Metastatic small cell lung cancer

The proposed rule also cites the New COVID-19 Treatment Add-On Payment (NC-TAP), which was implemented on Nov. 2, 2020. This provides for additional payment for items that do not qualify for NTAP, but treat COVID-19. An item cannot receive both NC-TAP and NTAP payment; if the item is approved for NTAP, then it will not receive NC-TAP. This additional payment will remain in effect until the end of the fiscal year, when the end of the pandemic is declared. For example, if the pandemic is declared over in July 2021, then the NC-TAP will end Sept. 30, 2021. If the pandemic was declared over in November 2021, then the NC-TAP would remain in effect until Sept. 30, 2022.

There are 12 items that are proposed for the New Technology Add-On Payment Alternative Pathway. These items include the following:

Item

Treatment Of/ Description of Use

Aprevo Intervertebral Body Fusion Device

Stabilizes lumbar spinal column

aScope Duodeno

Single-use endoscope for upper GI procedures

Caption Guidance

Artificial intelligence-guided medical image acquisition software – cardiac ultrasound

CERAMENT G

Osteomyelitis

EXALT Model DP

Single-use duodenoscope for use during ERCP

FUJIFILM EP-7000X System

Used during thoracic, abdominal, gynecologic procedure

Harmony Transcatheter Pulmonary Valve (TPV) System

Severe pulmonary regurgitation

Neovasc Reducer

Refractory angina

Phagenyx System

Neurogenic dysphagia

Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PRCFC)

Fibrinogen deficiency-related bleeding

Shockwave C2 Intravascular Lithotripsy (IVL) System

Lithotripsy-enabled, low-pressure dilation of calcified, stenotic de novo coronary arteries prior to stenting

Thoraflex Hybrid Device

Damaged/diseased aortic arch or descending aorta, with or without ascending aorta involvement

There is one last item that has been proposed under the Qualified Infectious Disease Products (QIDP). CONTEPO is used to treat complicated urinary tract infections. 

It is important to note these New Technology Add-On Payment items, as the reimbursement is paid in addition to the MS-DRG payment. These payments are triggered by the ICD-10-PCS code, unless otherwise noted in the regulations. The increased number of proposals has impacted the activity in the Coordination and Maintenance Committee meeting, as many of the new proposals have ICD-10-PCS codes requested. As you identify the items that are used by your facility, you should also identify which documentation can be used to identify the items. The items and documentation should be part of your education for IPPS FY 2022.

Programming Note: Listen to Laurie Johnson’s live coding report every Tuesday during Talk Ten Tuesdays, 10-10:30 a.m. Eastern.

 

Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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