Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
The new ICD-10-PCS codes that are used for reporting the use of therapeutic substances in a COVID-19 patient do not impact the MS-DRG assignment. It is recommended that these codes be reported when applicable. This will allow help with tracking and determining effectiveness of each substance used with the COVID-19 patient outcomes. Some of them are New Technology (NTAP) payment drugs that the hospital would receive additional reimbursement for.
These new ICD-10-PCS codes are only assigned if they are being administered to treat COVID-19.
New Technology Payment (NTAP) codes are indicated by * These include those approved for FY2022 and prior years. Note that some “Codes in the New Technology” section of ICD-10-PCS may be new, but may not be approved for additional NTAP payment. They should still be reported.
Coders should only report the drug administration code once even if the drug is administered multiple times. If multiple drugs are used, each one would be reported once if the drug falls within the new technology drugs listed below.
All of the new technology drugs listed below are from New Technology Group 5.
If Dexamethasone is used to treat the COVID patient, and the facility wants it captured, it should be reported with the appropriate code from table 3E0 for introduction of anti-inflammatory drug. A code from the New Technology list would not be appropriate.
ICD-10-PCS | Specific Drugs to Treat COVID-19 | New Technology
- Remdesivir (VEKLURY©) (code is specific for route central vs. peripheral vein) XW033E5 for administration via peripheral vein or XW043E5 for administration via central vein (NTAP $2,028)
- Sarilumab (code is specific for route central vs. peripheral vein) XW033G5 for administration via peripheral vein or XW033G5 for administration via central vein
- Tocilizumab (code is specific for route central vs. peripheral vein) XW033H5 for administration via peripheral vein or XW043H5 for administration via central vein
- Olumiant® (baricitinib) Codes could be 3E0DXGC, 3E0G7GC, XW0DXF5, 3E0H7GC, XW0DXM6, XW0G7M6, XW0H7M6 (Did not receive FDA approval by 7/1/21. This will receive NCTAP for Covid payments through FY2022 but not for new technology.
ICD-10-PCS | Convalescent Plasma and Globulins to Treat COVID-19 | New Technology
- Convalescent Plasma (code is specific for route central vs. peripheral vein) XW13325 for administration via peripheral vein or XW14325 for administration via central vein
- Effective 10/1/21 – High-Dose Intravenous Immune Globulin (code is specific for central vs peripheral vein) XW133D7 for peripheral vein or XW143D7 for central vein administration
- Effective 10/1/21 – Hyperimmue Globulin (code is specific for central vs peripheral vein) XW133E7 for peripheral vein or XW143E7 for central vein administration
ICD-10-PCS | Drugs Not Classified Elsewhere | New Technology
- Introduction of Other New Technology Therapeutic Substance into Subcutaneous tissueXW013F5
- Introduction of Other New Technology Therapeutic Substances (code is specific for route central vs. peripheral) XW033F5 for administration via peripheral vein or XW043F5 for administration via central vein
- XW0DXF5 Introduction of other new technology therapeutic substance into mouth and pharynx, external approach, new technology group 5 for oral meds (or other specific XW0DX- code as they become available in oral form)
Coders should follow the guidance for reporting COVID-19 provided by the AHA. This is updated frequently and should be reviewed with each revision. If you are not familiar with the AHA FAQ for coding COVID-19 cases, please visit https://www.codingclinicadvisor.com/faqs-icd-10-cm-coding-covid-19 and download the most current version.
American Hospital Association (AHA) Frequently Asked Questions Regarding ICD10-CM/PCS Coding for COVID-19, Revised August 27, 2021
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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.
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