ICD-10-PCS Medical and Surgical Section:
Temporary Balloon Occlusion
Severe trauma and AAA aneurysm rupture can lead to non-compressible torso hemorrhage (NCTH) – a hemorrhagic focus that is inaccessible to a tourniquet or pressure dressing, Temporary balloon occlusion is often performed via a percutaneous approach but can be performed using an open approach. The changes below enable the capture of procedures such as the open temporary occlusion of the descending or abdominal aorta using a balloon.
Table 02L Occlusion of Heart and Great Vessels: Add the approach value 0 Open, applied to the body part value W Thoracic Aorta, Descending, for the device value D Intraluminal Device and qualifier value J Temporary.
Table 04L Occlusion of Lower Arteries: Add the approach value 0 Open applied to the body part value, 0 Abdominal Aorta for the device value D Intraluminal Device and qualifier value J Temporary.
Laser Interstitial Thermal Therapy (LITT)
Laser interstitial thermal therapy (LITT) is a minimally invasive treatment using a focused beam of electromagnetic radiation emitted from a laser that is stereotactically placed into a targeted location. The laser then induces hyperthermia to ablate the target minimizing injury to the surrounding tissues while magnetic resonance imaging (MRI) thermography is used to monitor tissue temperatures. The use of laser interstitial thermal therapy (LITT) is currently being researched to include but not limited to the following indications, brain tumors and breast tumors, prostate cancer, osteoid osteoma (bone tumor), lung cancer, liver cancer, radiation necrosis and epilepsy. These changes below enable capture of detail for procedures such as Laser Interstitial Thermal Therapy (LITT) of the vertebra.
Table 0P5 Destruction Upper Bones: Add qualifier value 3 Laser Interstitial Thermal Therapy for the body part values 3 Cervical Vertebra and 4 Thoracic Vertebra.
Table 0Q5 Destruction Lower Bones: Add qualifier value 3 Laser Interstitial Thermal Therapy for the body part values 0 Lumbar Vertebra and 1 Sacrum.
ICD-10-PCS Administration Section:
Intraosseous Administration of Blood Products
Intraosseous infusion (IO) is the process of injecting medications, fluids, or blood products directly into the marrow of a bone, this provides a non-collapsible entry point into the systemic venous system. The intraosseous infusion technique is used to provide fluids and medication when intravenous access is not available or not feasible. Intraosseous infusions are used when people have compromised intravenous access and need immediate delivery of life-saving fluids and medications.
Table 302 Transfusion: Add the body part value T Bone Marrow, applied to the approach value, 3 Percutaneous for the blood product substance values listed below and qualifier values 0 Autologous and 1 Nonautologous. These changes enable the capture of procedures such as the intraosseous administration of blood products.
- H Whole Blood
- J Serum Albumin
- K Frozen Plasma
- L Fresh Plasma
- N Red Blood Cells
- P Frozen Red Cells
- R Platelets
ICD-10-PCS New Technology Section:
Table XW0 New Technology Introduction
- Add substance value G REGN-COV2 Monoclonal Antibody, applied to body part value 1 Subcutaneous Tissue and approach value 3 Percutaneous, to identify the subcutaneous administration of REGN-COV (Casirivimab and imdevimab). These changes enable the efficient tracking of this therapeutic when used in the treatment of COVID-19.
- Add new substance value K Sabizabulin. Sabizabulin is an orally administered antiviral/anti-inflammatory therapeutic. These changes enable the efficient tracking of this therapeutic when used in the treatment of COVID-19.
Table XW1 New Technology Transfusion
- Add substance value F OTL-103 for Body Parts 3 Peripheral Vein and 4 Central Vein. OTL-103 is a gene therapy for Wiskott–Aldrich syndrome, a rare primary immunodeficiency caused by mutations in the gene that codes for Wiskott–Aldrich syndrome protein (WASp). OTL-103 is an autologous cell therapy that uses the patient’s own CD34+ cells collected from bone marrow or peripheral blood. These are then transfected with a lentiviral vector that encodes for a functional Wiskott–Aldrich syndrome protein. The transfected cells are then reinfused to the patient. The cells migrate to the bone marrow, where they produce functional copies of Wiskott–Aldrich syndrome protein.
- Add substance value G OTL-200 for Body Parts 3 Peripheral Vein and 4 Central Vein. OTL-200 is an autologous CD34+ cell-enriched population that contains hematopoietic stem and progenitor cells (HSPC) transduced ex vivo using a lentiviral vector encoding the ARSA gene for the treatment of patients diagnosed with Metachromatic leukodystrophy (MLD). OTL-200 can be given in presymptomatic or early symptomatic MLD, depending on the MLD subtype. If approved by the FDA, OTL-200 would be the first ex vivo autologous HSC-GT available for use in the US intended for the treatment of patients diagnosed with MLD. Metachromatic leukodystrophy (MLD) is a rare and life-threatening inherited disease of the body’s metabolic system. Over time, the nervous system is damaged, leading to neurological problems such as motor, behavioral and cognitive regression, severe spasticity, and seizures. MLD is classified by the age at which symptoms first develop into early onset disease.
- Add substance value J Exagamglogene Autotemcel (exa-cel) for Body Parts 3 Peripheral Vein and 4 Central Vein. The Beta (β)-hemoglobinopathies, which include β-thalassemia and sickle cell disease (SCD), are among the most prevalent monogenic (meaning caused by variation in a single gene) disorders worldwide. In transfusion-dependent β-thalassemia (TDT), the most clinically severe form of the disease, patients require long-term red-cell transfusions for survival and the prevention of serious complications. Exa-cel is designed to modify a patient’s blood cell precursors to produce high levels of fetal hemoglobin (HbF). HbF is a form of oxygen-carrying hemoglobin found in newborn red blood cells that transports oxygen more efficiently than its adult equivalent (Hb). HbF can substitute for the diseased hemoglobin in TDT and SCD patients, reducing or eliminating symptoms. As a therapy, exa-cel involves isolating a patient’s own hematopoietic stem cells (HSCs), editing them with to increase HbF in the red blood cells, and then returning the edited cells to the patient through a stem cell transplant. The elevation of HbF by exa-cel has the potential to alleviate or eliminate transfusion requirements for patients with TDT and reduce painful and debilitating sickle crises for patients with SCD. Exa-cel is being studied in clinical trials.
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