Key Takeaways from March 2017 Coordination & Maintenance Committee Meeting

The Coordination and Maintenance (C&M) Committee Meeting was held March 7 and 8 at the Centers for Medicare & Medicaid Services (CMS) headquarters, for the purposes of reviewing proposals for new ICD-10-CM (diagnosis) and ICD-10-PCS (procedures) for fiscal years 2018 and 2019.

The agenda was full and required two full days of presentations to complete. The presentations included some frequently discussed issues, as well as renewed discussion of subjects that were covered in previous meetings. The meeting confirmed that there will not be new diagnosis or procedure codes released in April 2017.

Here are some important upcoming dates. Comments regarding the proposed diagnosis and procedure codes for which expedited action was requested are due on April 7. These applications are for Oct. 1, 2017. Comments regarding ICD-10-CM can be sent to the Centers for Disease Control and Prevention (CDC) at nchsicd10CM@cdc.gov. The comments for ICD-10-PCS can sent to CMS at ICDProcedureCodeRequest@cms.hhs.gov. The proposed rule for the Inpatient Prospective Payment System (IPPS) will be published in April 2017.   

The final diagnosis and procedure codes, guidelines, and addendum for the 2018 fiscal year will be published in June. July 14, 2017 is the due date for all requests for new code applications for the September Coordination & Maintenance Committee meeting. On Aug. 1, 2017, the IPPS Final Rule will be published with the last release of the General Equivalence Mappings (GEMs). CMS has stated in the past that there would be three years of GEMs published after the implementation of ICD-10-CM/PCS. A conversion table will also be released, which will assist in the translation of ICD-10 codes from year to year going forward. Sept. 1 is the deadline to register for the next Committee meeting, if you want to attend in person. Anyone who attends via webcast is not required to register. The next Committee meeting will be Sept. 12 and 13 at CMS headquarters in Baltimore. Oct. 1, 2017 will be the beginning of the 2018 fiscal year. 

The diagnosis code proposals included acute appendicitis, perforation of the gallbladder, diverticular disease of the intestine, non-healing traumatic/surgical wound, non-procreative genetic counseling, osteoporosis related to pathologic fracture of ribs and pelvis, breakthrough pain, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), disorders of metabolism gamma aminobutyric acid (GABA), blepharitis, brow ptosis, epiphora, eyelid cancer, hemifacial spasm, lagophthalmos, Meibomian gland dysfunction, paralytic ectropion, rosacea conjunctivitis, thyroid eye disease, nonruptured cerebral aneurysm, screening for certain developmental disorders, fetal inflammatory response syndrome (FIRS), immunizations not carried out, immunocompromised status, multiple sulfatase deficiency (MSD), admission for rehabilitation, urethral stricture, factitious disorder (also known as Munchausen’s Disorder), secondary mesothelioma and mesothelioma in remission, lacunar infarct, infection following procedure, infection of obstetric wound, and antenatal screening. Expedited consideration has been requested for classification of myocardial infarction types, heart failure classifications, electronic delivery system (of nicotine and other substances), orbital roof/wall fracture, pediatric Glasgow coma scale, and substance use disorder in remission.

The procedure proposals included new substances as well as new techniques and devices for Oct. 1, 2017 implementation. The following topics were presented without a request for new technology add-on payment status: oxidized zirconium on polyethylene bearing surface for hip and knee arthroplasty, renal replacement, occlusion of left atrial appendage, resection of LVOT, Fontan completion Stage II, Alfieri stitch valvuloplasty, ligation of main pulmonary artery/trunk, fluoroscopy of main pulmonary artery, release of myocardial bridge, and endovascular intracranial thrombectomy. The magnetically controlled growth rods procedure had a request for revision and not a new code. This procedure was approved for new technology add-on payment for 2017. New technology status was requested for the following procedures for 2018: ZINPLAVA, radiotherapeutic brain implant, administration of VYXEOS, and administration of KTE-C19.

New technology status has been requested for the following procedures for the 2019 fiscal year: cerebral embolic protection during transcatheter aortic valve replacement (TAVR), endovascular cardiac implant, combined thoracic arch replacement with thoracic aorta restriction, and spinal fusion with radiolucent interbody fusion device.

A code for admission for rehabilitation may solve the problem that facilities are currently having in assigning cases to the MS-DRGs for rehabilitation (945 and 946). There were a few codes in ICD-9-CM that were first listed or principal diagnosis codes. This proposal that is not supported by the CDC is to use the admission for rehab code as a secondary diagnosis. ICD-10-CM does have diagnosis codes that include “procedures,” such as admission for radiotherapy and antineoplastic chemotherapy, which can be first listed. It appears to be inconsistent to have the admission for rehabilitation codes as secondary diagnosis codes. Public comments may influence a change or acceptance of this proposal.

Other exciting proposals are the new codes for heart failure classifications and myocardial infarction types. Physicians are consistently documenting this specificity so the diagnosis codes are behind the documentation. Note that the heart failure classification is not the New York Hospital Association classifications, but those introduced by the American College of Cardiology and the American Heart Association. Some of the proposals include adding laterality.    

The new fiscal year for ICD-10-CM/PCS is going to be another exciting time, with more additions and revisions to the code sets. Make sure to comment on the proposals for the 2018 codes by April 7, 2017, and look for the final lists to be published in June 2017.