C&M Meeting: Plan for Classification Changes

Public comments due by Nov. 8 to CMS and CDC.

EDITOR’S NOTE: Senior healthcare consultant Laurie Johnson reported this story live during the Sept. 17 edition of Talk Ten Tuesday. The following is an edited transcript of her reporting.

The Coordination and Maintenance Committee met on Sept. 10-11, 2019 at the Centers for Medicare and Medicaid Services (CMS) headquarters.   The purpose of these meetings was to discuss submitted proposals for changes to ICD-10-CM and ICD-10-PCS.   The procedure proposals were discussed first.     The procedure proposals included the following:

1. Intraoperative Near-Infrared Fluorescence Imaging of the Hepatobiliary System Using Indocyanine Green Dye
2. Near Infrared Spectroscopy for Tissue Viability Assessment
3. Cesium-131 Brachytherapy
4. Intravascular Ultrasound Assisted Thrombolysis
5. Administration of Nerinitide
6. Administration of Eladocagene Exuparvovec
7. Administration of Zulresso
8. Section X Updates

Many of these proposals included the administration of a new substance.

The presentation on the Section X updates included a review of reporting frequency for codes adopted in New Technology Year 1, New Technology Add-on Payment (NTAP) application, and if NTAP was adopted.   

The data shows that 14 percent  of the procedure codes were adopted for New Technology Add-On payment.  The reporting frequency appears to be rising.    CMS will need to decide if procedures remain in Section X, are reassigned to Med/Surgical section of PCS, or are deleted.

A discussion regarding the development of the ICD-10-PCS classification generated many comments from the attendees.    The classification is at a crossroads as decisions arise regarding how to deal with deleted codes (as was done for FY20); how to utilize the New Technology and Other Procedure sections; and standardizing the meaning of characters.    

The addenda provided new approach characters for Table 0W9J (drainage of pelvic cavity).   The approaches proposed to be included are 7 (natural or artificial opening) or 8 (natural or artificial opening endoscopic).

The highlight of the diagnosis portion was a discussion on sepsis.   This discussion included definitions of Sepsis 3 which states that sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.  Septic shock is a subset of sepsis.  Sepsis is not a linear progression is currently assumed by the ICD-10-CM classification.  Systemic Inflammatory Response Syndrome (SIRS) is no longer defining criteria of sepsis and can develop from a non-infectious origin.  It was also mentioned that inconsistent use of terminology has created problems with coding.    The sepsis proposal includes the removal of severe sepsis from ICD-10-CM.

The diagnosis proposals included abnormal neonatal screening, aromatic L-amino acid decarbylase (AADD) deficiency, chimeric antigen receptor T-cell (CAR-T) status, cyclin-dependent kinase-like 5 (CDKL5) deficiency, fetal anomalies, identification of specific synthetic opioids, irregular eye movement, isthmocele, juvenile osteochondrosis of tibia and fibula, macular hole, other specified conditions affecting pregnancy, childbirth, and the puerperium, Powassan virus disease, problems related to upbringing, pulp polyp, recurrent caries, refractory gastroesophageal reflux disease, superficial injury of thorax (bilateral and middle), therapeutic and rehabilitative ophthalmic devices, cytokine release syndrome, electric scooter and other micro-mobility devices, Friedreich ataxia, gastric intestinal metaplasia, hypereosinophilic syndromes and other eosinophil diseases, immunodeficiency status, intracranial hypotension and cerebrospinal fluid leak, pediatric feeding disorder, pulmonary eosinophilic diseases, sickle cell disease, stage 3 chronic kidney disease, Tarlov cyst, X-linked myotubular myopathy and other congenital myopathies, and addenda of Index and Tabular volumes.  

In conclusion, the development of ICD-10-CM and ICD-10-PCS requires input from clinical resources as well as the organizations and people that regularly utilize these classification systems.    Review the proposals that are listed below and provide your feedback.   The recordings are available to review for additional information.  Comments on the proposals are due to the Center for Disease Control  and Prevention (CDC) and CMS by Nov. 8, 2019.   

Resources:

https://www.cdc.gov/nchs/icd/icd10cm_maintenance.htm

https://www.cms.gov/Medicare/Coding/ICD10/C-and-M-Meeting-Materials.html