Coding in the Time of Covid: CMS releases 12 New ICD-10-PCS

C. Matheson MRA, Coding Leave a Comment

During this time of year in the coding world we are preparing for the October 1st ICD-10-CM and PCS coding updates, but we were recently surprised with an announcement on July 30th from The Centers for Medicare and Medicaid (CMS). Twelve new ICD-10-PCS procedure codes concerning Covid-19 therapeutics became effective August 1, 2020. 

Per the CMS website announcement on July 30, “In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) is implementing 12 new procedure codes to describe the introduction or infusion of therapeutics, including Remdesivir and convalescent plasma, into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective August 01, 2020.” 

With the new changes, ICD-10-PCS now identifies specific codes for Remdesivir and convalescent plasma. Two other named substances, Sarilumab and Tocilizumab, have their own PCS codes as well. The new procedure codes are described and broken down in the tables below.  

The new ICD-10-PCS codes do not specify that they are for treatment of COVID-19. They specify only the treatment procedure. ICD-10-CM code diagnosis reporting information is utilized to identify the disease.  

PCS Table XW0

PCS Code  Code Description  Applicable Trade Name 
XW033E5  Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5  Remdesivir (trade names Veklury and GS-5734) 

  

XW043E5  Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5  Remdesivir (trade names Veklury and GS-5734) 

  

XW033G5  Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5  Sarilumab (trade name KEVZARA®) 

  

XW043G5  Introduction of Sarilumab into Central Vein, Percutaneous Approach, New Technology Group 5 

Tocilizumab 

Sarilumab (trade name KEVZARA®) 

  

XW033H5  Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5

 

Tocilizumab (trade name ACTEMRA®) 

  

XW043H5  Introduction of Tocilizumab into Central Vein, Percutaneous Approach, New Technology Group 5 

  

Tocilizumab (trade name ACTEMRA®) 

  

  

PCS Table XW1- Convalescent plasma (nonautologous) 

PCS Code

 

Code Description 
XW13325  Transfusion of Convalescent Plasma (Nonautologous) into Peripheral Vein, Percutaneous Approach, New Technology Group 5 
XW14325  Transfusion of Convalescent Plasma (Nonautologous) into Central Vein, Percutaneous Approach, New Technology Group 5 

 

There were also 4 new procedure codes created in PCS Table XWO to capture non-specific administration of COVID-19 therapeutics not classified elsewhere. The four codes capture therapeutics administered via central or peripheral IV infusion, subcutaneous injection or as an oral medication. No specific substances have been designated for these codes thus far. The four non-specific codes are listed below. 

 

Table XW0 – Other New Technology Therapeutic Substance 

PCS Code  Code Description 
XW013F5  Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5

 

XW033F5  Introduction of Other New Technology Therapeutic Substance into Peripheral Vein, Percutaneous Approach, New Technology Group 5

 

XW043F5  Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5 
XW0DXF5  Introduction of Other New Technology Therapeutic Substance into Mouth and Pharynx, External Approach, New Technology Group 5 

All of the new codes are designated with the qualifier New Technology Group 5, rather than New Technology Group 6 which is used for the new FY 2021 PCS codes posted on the CMS website on May 28. This is because they are valid on August 1 and therefore are retroactively included in the FY 2020 update. The new codes and associated official ICD-10-PCS content are posted in a separate set of addenda files.  

  

From an MS-DRG perspective, the new codes are all designated as Non-OR codes and will not affect DRG assignment. However, they should be used for data reporting and tracking clinical outcomes associated with these treatments. Accurate code assignment of the newly created codes has the potential to be very important and provide valuable data. 

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