MEd, RHIA, CCS,
CCS-P, Director of HIM
New medical services and technologies are constantly emerging and changing to better meet the needs of patients. However, the cost to provide them can result in a significant loss of money to the hospital if reimbursement does not meet the higher cost. For this reason, an important billing and coding update facing the industry today is the new technology add-on payments, which work to provide additional payment for these breakthrough technologies.
According to the FY 2012 IPPS final rule (76 FR 51572 through 51574), the new technology must meet the following criteria, in order to be considered for this add-on payment:
- It must be new
- It must cost enough that the MS-DRG rate applicable would be inadequate
- It must demonstrate substantial clinical improvement over existing services or technologies
Within the ICD-10-PCS classification system, Section X includes all codes that are not currently classified in ICD-10-PCS or that identify procedures that have been requested through the new technology application process. Often, these are new medical services and technologies that are not captured by coding professionals, or do not have the necessary specificity required within the current tables. By adding these codes, data can be gathered to determine whether these new technologies meet the add-on payment criteria. For fiscal year 2019, five new codes were added in the New Technology section, which includes one new table (XV5) and two new rows in the existing table XW0.
The new table XV5 was created to capture the use of aquablation therapy, used to resect the prostate as a treatment for benign prostatic hyperplasia. This new technology is a waterjet ablation therapy that removes prostate tissue using a high-velocity stream of saline combined with robotic assistance to destroy the targeted portion of the prostate. Use of the waterjet eliminates the risk of thermal injury or other complications that may arise when the prostate is removed with other therapies, such as electrocautery, laser enucleation, plasma vaporization, or others. The ICD-10-PCS code XV508A4 – Destruction of Prostate using Robotic Waterjet Ablation, Via Natural or Artificial Opening Endoscopic, New Technology Group 4, will be assigned beginning Oct. 1, 2018, for use of this advanced technology.
Table XW0 already exists in ICD-10-PCS, but four new codes were created to capture the intravenous administration of plazomicin anti-infective and synthetic human angiotensin II via a peripheral or central vein. Plazomicin has been approved by the FDA for the treatment of complicated urinary tract infections for patients with limited or no treatment options available to combat these aggressive bacteria. The two codes created to capture administration of this new substance are:
- XW033G4 Introduction of Plazomicin Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 4
XW043G4 Introduction of Plazomicin Anti-infective into Central Vein, Percutaneous
- Approach, New Technology Group 4
Another example of new codes in Table XW0 is Giapreza, an FDA-approved synthetic human angiotensin II used to raise the critically low blood pressure in a patient with septic or other distributive shock, which can affect blood flow to vital organs. When combined with conventional treatments, Giapreza helps increase blood pressure by leveraging the renin-angiotensin-aldosterone system to aid in blood pressure stabilization. The two codes created to capture administration of this new substance are:
- XW033H4 Introduction of Synthetic Human Angiotensin II into Peripheral Vein, Percutaneous Approach, New Technology Group 4
- XW043H4 Introduction of Synthetic Human Angiotensin II into Central Vein, Percutaneous Approach, New Technology Group 4
Centers for Medicare and Medicaid Services (CMS) received 15 applications for new technology add-on payments for FY 2019, including the three new technologies mentioned above. As of July 2018, only the proposed rule is available, which provides CMS evaluation and analysis of these applications. The proposed rule includes any concerns in regard to whether criteria are met for each new technology and requests public comments. Once the final rule is released, these applicants will know if their request for add-on payment has been approved—an important step in providing and reimbursing for the advanced services and technologies in the industry today.