12 New Codes to Identify Therapeutics

12 New Codes to Identify Therapeutics

And that’s not all: CMS has issued new coding guidance, too.

The Centers for Medicare & Medicaid Services (CMS) implemented 12 new ICD-10-PCS codes to allow Medicare and other insurers to identify the use of the therapeutics Remdesivir and Convalescent plasma for treating hospital inpatients with coronavirus (COVID-19).

The new codes, effective Aug. 1, are:

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

XW033E5 Introduction of Remdesivir Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 5

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

XW033G5 Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5

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

XW043E5 Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5

XW043F5 Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5

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

XW043H5 Introduction of Tocilizumab 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

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

Download the system update files from the CMS website.

shutterstock copyright TANYARICO

CMS Clarifies Cost-Sharing Guidelines

There have been a lot of mid-year updates to code sets and coding guidelines due to the public health emergency for COVID-19. There have also been a lot of updates to those updates.

For example, CMS revised MLN Matters article SE20011 on July 24 to add clarifying language to the Families First Coronavirus Response Act Waives Coinsurance and Deductibles for Additional COVID-19 Related Services section. The revision shows that the guidance applies to lab tests regardless of the codes used to report those tests. This pertains to the use of Modifier CS.

Counseling Counts, too, CMS Says

CMS revised MLN Matters article SE20011 again, on July 30, to add the Counseling and COVID-19 Testing section.

In brief, CMS is advising physicians to counsel, test, and refer patients for case tracing at the same encounter. “Working in partnership with public health personnel, providers could speed the counseling, testing, and referrals for case tracking initiation to reduce potential exposures and additional cases of COVID-19,” the agency states in MLN Matters article SE20011.

How do you bill for counseling at an encounter for COVID-19 testing?

Use existing and applicable coding and payment policies for patients with Original Medicare, CMS says. Let time be the determining factor for evaluation and management (E/M) visits when physicians and other qualified healthcare practitioners spend more than 50 percent of their time with the patient providing counseling or coordination of care.

CMS also released a counseling checklist and talking points fact sheet on July 30.

Related Knowledge Center article: COVID-19 Specimen Collection and Testing

CPT® 87426 is a Waived Test After All

On July 24, CMS released transmittal 10230 to inform stakeholders of the latest tests approved by the Food and Drug Administration (FDA) as waived tests under the Clinical Laboratory Improvement Amendments Act (CLIA). Later that same day, CMS issued MLN Matters article MM11927 to inform stakeholders about a new code approved by the FDA as a waived test under the CLIA: CPT® code 87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]).

Related Knowledge Center article: New COVID-19 Test Codes Effective Immediately

Residents Can Do More During PHE for COVID-19

CMS expanded CPT® codes that may be billed with modifier GE (under 42 CFR 415.174) on and after March 1, 2020, for the duration of the public health emergency:

  • Residents furnishing services at primary care centers may provide an expanded set of services to beneficiaries, including:
    • Levels 4-5 of an office/outpatient E/M visits (99204-99205, 99214-99215)
    • Telephone E/M (99441-99443)
    • Transitional care management (99495-99496)
    • Some communication technology-based services (99421-99423, 99452, G2010, and G2012)

“Teaching physicians may submit claims for these services furnished by residents in the absence of a teaching physician using modifier GE,” according to the July 9 MLN Connects.

Medicare Administrative Contractors will automatically reprocess claims billed with modifier GE Service has been performed by a resident without the presence of a teaching physician under the primary care exception on or after March 1, 2020, that were denied. You do not need to do anything.

Evaluation and Management – CEMC

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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