Reporting of newly approved NTAP technologies, devices and substances for FY 2025 went into effect on October 1. Two new substances that received NTAP approval are Casgevy™ and Lyfgenia™. Both of these medications are gene therapies that have indications for the treatment of sickle cell disease and when used for this purpose their administration qualifies for a significant NTAP. The maximum NTAP payment a hospital can receive for administration of Casgevy™ is $1,650,000.00 and for Lyfgenia™ is $2,325,000.00. Recognizing the substantial reimbursement amounts associated with these medications underscores the importance of being diligent in capturing every NTAP approved procedure. The following provides some tips and advice for ensuring that every NTAP approved procedure is identified and correctly reported, leading to appropriate and optimal reimbursement.
It doesn’t matter if the coder recognizes that a technology/device/substance is an NTAP designated procedure and should be coded if the wrong code is assigned. NTAP payment is tied to reporting of specific ICD-10-PCS codes, so assigning the exact code(s) associated with the new technology payment is crucial.
Keeping a few important points in mind will aid in coding that correctly captures NTAP revenue.
NTAP procedures can come from the New Technology section of ICD-10-PCS, but codes with NTAP designation can also come from other sections, such as the Medical and Surgical or Administration section. Coders need to be careful to assign codes from the correct section of ICD-10-PCS when reporting NTAP approved procedures. For example, assigning a code from the Administration section of ICD-10-PCS for administration of a substance that should be more specifically reported with a New Technology code that qualifies for NTAP will not result in capturing NTAP revenue.
Example: Administration of Lunsumio™
In addition to the necessity of coding from the correct section of ICD-10-PCS, proper coding to capture NTAP requires assigning the ICD-10-PCS character values appropriate to the new technology.
Example: Root operation selection for administration of Casgevy™ or Lyfgenia™
Because Casgevy™ and Lyfgenia™ are comprised of blood stem cells, administration of these substances meets the definition of the root operation Transfusion.
| Transfusion | Definition: Putting in blood or blood products |
Coders should be careful NOT to assign a code with the root operation Introduction for administration of Casgevy™ or Lyfgenia™. Doing so would lead to missing the significant additional reimbursement associated with the NTAP status of these substances.
| Introduction | Definition: Putting in or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products |
Coders should be so familiar with the list that they immediately recognize an NTAP designated technology/device/substance if it’s documented in the record.
Some NTAP designated technologies/devices/substances may be referenced by more than one name. For example, substances and devices may have both a brand and a generic name and use of some devices may be documented with or without a reference to the manufacturer. Familiarity with all names for each NTAP designated item will increase the likelihood of recognizing when an NTAP designated procedure is documented.
Being familiar with the diagnoses that the NTAP technologies, devices or substances are intended to treat is as important as being familiar with the NTAP designated items themselves. Recognizing these diagnoses in the documentation should prompt the coder to make a careful review of the rest of the record to determine if an NTAP approved item was used in treating the patient.
For example, in patients 12 years and older with sickle cell disease and recurrent vasoocclusive crises, cases should be carefully reviewed to determine if NTAP designated gene cell therapy with Casgevy™ (exagamglogene autotemcel) or Lyfgenia™ (lovotibeglogene autotemcel) was administered.
Code selection should always be made based on application of the coding conventions and guidelines to the documentation in the health record. However, the NTAP list includes the codes that have been identified for reporting NTAP associated procedures. It is recommended to check the documentation against the codes provided to determine if the procedure performed meets the definition of the ICD-10-PCS code assigned to the NTAP designated procedure.
Organizations will be anxious to collect the additional revenue that comes from correct reporting of NTAP approved items. Since this is the case, they should be happy to assist coders in identifying when NTAP designated procedures are provided to ensure their reporting does not get overlooked. If your organization has not approached you about particular ways to recognize provision of NTAP designated procedures that are specific to their systems, take the initiative and ask the following questions:
It’s better to ask for clarification or assistance than to miss reporting or incorrectly report a procedure with a significant amount of associated additional revenue.
To review more comprehensive coverage of the technologies, devices and substances that qualify for NTAP in FY 2025, including a list with a description of the technology, the relevant diagnosis and procedures codes and the maximum payment organizations can receive for these procedures, take our HIALearn course FY 2025 IPPS Updates or purchase HIA’s FY 2025 NTAP Resource.
References
FY 2025 IPPS Final Rule Home Page
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.