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Section X marks the spot for New Technology in ICD-10-PCS

JustCoding News: Inpatient, July 29, 2015

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The Cooperating Parties added a 17th section to the ICD-10-PCS Manual for 2016: Section X (New Technology).

Section X provides a place for codes that uniquely identify procedures requested via the New Technology Application Process or that capture other new technologies not currently classified in ICD-10-PCS, according to CMS.

“The X codes are solutions for a challenge CMS has faced, trying very hard to have unique, identifiable codes for new technologies,” says Pat Brooks, RHIA, senior technical advisor for CMS' Hospital and Ambulatory Policy Group.

Stakeholders expressed concern about putting very specific new technology codes within the main body of ICD-10-PCS, Brooks says. They also expressed concerns that some of the very detailed code requests are not things that typically are captured within the body of ICD-9-CM Volume 3 or ICD-10-PCS.

Stakeholders suggested CMS create a new section as a way to easily capture very specific new technologies. Codes for new technologies that are consistent with current ICD-10-PCS codes may still be created within the current ICD-10-PCS structure, Brooks adds.

New Technology codes are standalone codes, not supplemental codes. These codes fully represent the specific procedure described in the code title, and do not require any additional codes from other sections of ICD-10-PCS. When section X contains a code title that describes a specific new technology procedure, report only the X code. Do not report a broader, non-specific code in another section of ICD-10-PCS.

Uses for New Technology codes

This section includes codes for medical and surgical procedures, medical and surgical-related procedures, or ancillary procedures designated as new technology.

Section X codes use the same root operation and body part values as their closest counterparts in other sections of ICD-10-PCS.

“The good news is you won’t have to learn a whole set of new reoperations simply because you want to find an X code,” Brooks says. “A second feature is the X codes are for types of technologies that are not usually captured by coders or do not usually have the desired specificity within the current ICD-10-PCS structure required for new technology approval.”

In fact, the meanings of the first five characters in New Technology are the same as the meanings in Medical and Surgical:

  • Section
  • Body system
  • Root operation
  • Body part
  • Approach

However, character 6 represents device/substance/technology instead of only device. The seventh character defines the New Technology Group instead of the qualifier.

The New Technology Group is a number or letter that changes each year that new technology codes are added to the system. For example, Section X codes added for the first year have the seventh character value 1 (New Technology Group 1).

The seventh character, the qualifier, just says New Technology Group 1, which is something that’s unique to section X, says Rhonda Butler, CCS, CCS-P, senior clinical research analyst with 3M Health Information Systems in Salt Lake City.

“It allows us to be able to recycle the values to make them as consistent as possible with the section that they are most closely related to in PCS,” she adds.

“The plan is that every year this qualifier changes new technology group. We’re starting with New Technology Group 1 for October 1, 2015. Then if any new technology codes were created the following year, they would be New Technology Group 2.”

The qualifier is not anything specific that coders actually need to know. It doesn’t affect the code itself, Butler says. It’s just a way of keeping section X as flexible and useful as possible.

The New Technology section includes three root operations:

  • C, Extirpation (taking or cutting out solid matter from a body part)
  • 0, Introduction (putting in or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products)
  • 2, Monitoring (determining the level of a physiological or physical function repetitively over a period of time)

Each root operation has only one possible body system. Extirpation can only be reported for procedures in the cardiovascular system, while Introduction procedures involve anatomical regions. Monitoring is only reported with joints. Extirpation and Introduction procedures in New Technology always use a percutaneous approach, while Monitoring requires an open approach.

New Technology infusion

Consider the two new codes for the infusion of Ceftazidime-Avibactam, a new technology antibiotic that requires unique procedure codes. The codes use the same root operation (Introduction) and body part values (central vein and peripheral vein) in section X as the infusion codes in section 3 (Administration).

For introduction of Ceftazidime-Avibactam anti-infective into a central vein, report ICD-10-PCS code XW04321, Brooks says. Do not report a separate code from table 3E0 in the Administration section.

Blinatumomab, an antineoplastic immunotherapy drug, is another new technology drug. It is administered by intravenous infusion, and it treats certain special types of leukemia, according to Butler.

For this new technology drug, ICD-10-PCS includes two section X codes: one if it’s infused by a central vein and one if it’s infused by a peripheral vein, Butler says.

Two index entries were added to help coders find the correct code, she adds. In the Alphabetic Index, the name of the new technology device, substance, or technology for a section X code is included as a main term. In addition, all codes in section X are listed under the main term New Technology.

Coders can look up the drug under:

  • Blinatumomab Antineoplastic Immunotherapy
  • New Technology
    • Blinatumomab Antineoplastic Immunotherapy

Both entries direct coders to table XW0, Butler says. From there, coders only need to know which vein to complete the code:

  • XW03351 for a peripheral vein
  • XW04351 for a central vein

New Technology Extirpation

Orbital atherectomy technology is a new catheter-based technique for treating severely calcified coronary artery lesions, Butler says. This technology is reported using the root operation Extirpation in the New Technology section.

The body part character specifies the number of sites treated, just like the Medical and Surgical section table for coronary artery bypass graft procedures:

  • 0, coronary artery, one site
  • 1, coronary artery, two sites
  • 2, coronary artery, three sites
  • 3, coronary artery, four or more sites

Coders can look up the orbital atherectomy codes three ways:

  • Extirpation
    • Orbital Atherectomy Technology
  • Orbital Atherectomy Technology
  • New Technology
    • Orbital Atherectomy Technology

All three ways lead coders to table X2C, Butler says. All of the codes will have the same first three characters and the same final three characters.

Only character four will change. If the physician treats two coronary artery sites, coders will report X2C1361.

New Technology Monitoring

An intraoperative sensor is a disposable tibial insert used to aid orthopedic surgeons in placing prosthetic joint components during knee replacement surgery, Butler says.

Table XR2 includes two body part choices:

  • G, right knee joint
  • H, left knee joint

As with orbital atherectomy technology, only the body part character will change for the intraoperative sensor use. Coders can report:

  • XR2G021 for the right knee joint
  • XR2H021 for the left knee joint

Email your questions to associate product manager Michelle A. Leppert, CPC, at mleppert@hcpro.com.

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