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FY 2021 Updates

October 6, 2020

Listed below are some highlights from the FY 2021 updates. It is important to review these updates and determine if there are any changes in coding processes as well as identifying documentation in the electronic medical record which is applicable to the new codes. UASI offers 3 complimentary 1-hour webinars that provide additional and more detailed training for each of the sections discussed below.

ICD-10-CM Highlights:

  1. Sickle Cell Disorders:
    1. New codes have been added to more specifically identify complications in addition to acute chest syndrome and splenic sequestration. Other complications include a specific code for cerebral vascular involvement and other specified complications.
    2. Two new subcategories have been added to identify two distinct types of sickle cell thalassemia: sickle cell thalassemia beta plus (HbS-B+) and sickle cell thalassemia beta zero (HbS-B0).
  2. Specific codes to identify different types of acquired autoimmune hemolytic anemias (AIHA) to enable better tracking of these conditions. The new codes now specify three temperature-sensitive AIHA types. These three are called warm, cold, and mixed type AIHA, which denote the temperatures at which the autoantibodies best react with RBCs.
  3. New codes to identify Cytokine Release Syndrome (CRS). Cytokine Release Syndrome (CRS) is a condition that may occur after treatment with some types of immunotherapy, such as monoclonal antibodies and Chimeric Antigen Receptor T (CAR-T) Cell therapy. It is the most common reaction after CAR-T Cell therapy.
  4. New ICD-10-CM codes for substance abuse with withdrawal for those classes that can cause physiological addiction (i.e., alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, and other psychoactive substance).
  5. New codes for cerebrospinal leaks and intracranial hypotension. It is clinically important to differentiate between spontaneous CSF leaks and other CSF leaks, and also between cranial CSF leaks and spinal CSF leaks. Intracranial hypotension results from a loss of cerebrospinal fluid volume, and it is an under-recognized and under-diagnosed central nervous system disorder.
  6. New codes for corneal dystrophy a genetic eye condition in which one or more parts of the cornea lose their normal clarity as result of a buildup of cloudy material.
  7. New combination codes for bleeding associated with reflux esophagitis, specified esophagitis and unspecified esophagitis.
  8. New codes to specify both fentanyl and tramadol poisonings, adverse effect of and poisonings.

ICD-10-PCS Highlights:

  1. The device character “1 Radioactive Element” has been added to the root operation Insertion in several body systems. This supports a coding advice to assign a separate code for brachytherapy procedures when a radioactive source is left in the body at the conclusion of the procedure.
  2. New codes under the root operation Fragmentation for Intravascular Ultrasound Assisted Thrombolysis of major pulmonary vessels as well as upper and lower arteries and veins. The ultrasound does not itself dissolve the thrombus, but pulses of ultrasonic energy temporarily make the fibrin in the thrombus more porous and increase thrombolytic flow within the thrombus.
  3. In the Radiation Therapy section, a new isotope “Cesium 131” has been added to for treatment sites for Brachytherapy
  4. An “internal fixation device with sustained compression” was added to Fusion for Lower Joints and Upper Joints. These devices are used to hold bone ends together while they fuse, with the surgeon generally manually compressing the bones together before using the fixation devices to “lock” the bones in place.
  5. In the Heart & Great Vessels section a new qualifier – right atrium – was added to the root operation Bypass to capture a new percutaneous left-to-right atrial shunt, inserted as a treatment for congestive heart failure.

MS-DRGs:

  1. A new Pre MDC MS-DRG 018 Chimeric Antigen Receptor (CAR) T-cell Immunotherapy has been created. The creation of a new MS-DRG for CAR T-cell therapies would improve payment in the inpatient setting since CAR T-cell therapies are no longer eligible for new technology add-on payment significantly reducing the payment for these cases.  CAR T-cell therapy is a form of immunotherapy that uses specially altered T cells to fight cancer.
  2. In MDC 1 Procedure codes 037H04Z, 037J04Z, 037K04Z, 037L04Z, 037M04Z, and 037N04Z (open carotid artery dilation with an intraluminal device) will be reassigned from MS-DRGs 37, 38, and 39 Extracranial Procedures with MCC, with CC, and without CC/MCC, respectively to MS-DRGs 34, 35, and 36 Carotid Artery Stent Procedures with MCC, with CC, and without CC/MCC, respectively. In conducting their analysis CMS identified thirty-six additional ICD-10-PCS codes that involve open carotid artery dilation with multiple intraluminal devices will be shifted from MS-DRGs in MDC 5 to MS-DRGs 34, 35 and 36. 
  3. In MDC 3 MS-DRGs 129, 130, 131, 132, 133, and 134 have been deleted. New MS-DRGs 140, 141 and 142 are created for Major Head and Neck Procedures. MS-DRGs 143, 144, and 145 are created for other Ear, Nose, and Throat procedures. After completing an in-depth analysis of the procedures in these six MS-DRGs, it was found that they could be better classified. Tables 6P.2a, 6P.2b, and 6P.2c associated with the final rule for the finalized list of procedure codes that define the logic for the new MS-DRGs.
  4. In MDC 5 Procedure codes 02L70CK, 02L70DK, and 02L70ZK (occlusion od left atrial appendage) will be reassigned from MS-DRG 250/251 (percutaneous cardiovascular procedures without coronary artery stent) to 273/274 (percutaneous intracardiac procedures).
  5. Also, in MDC 5 twenty-four code combinations will be added for insertion of contractility modulation device and insertion of lead into the right ventricle or atrium, to MS-DRGs 222, 223, 224, 225, 226, and 227 Cardiac Defibrillator Implant with and without Cardiac Catheterization with and without AMI/HF/Shock with and without MCC, respectively. Additionally, twelve code pairs that involved the insertion of lead into the left ventricle or atrium will be deleted from those MS-DRGs, as they are clinically invalid.
  6. A new Pre MDC MS-DRG, 19, has been created for patients who have a simultaneous pancreas/kidney transplant and has hemodialysis during the same encounter as the transplant. New MS-DRGs 650 and 651 have been created for kidney transplant with hemodialysis, with and without MCC.