Proposed Rule and Code Changes Highlights - 2021

The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.

MS-DRG Proposed Changes

CMS wants to create a new MS-DRG specifically for CAR-T therapies, MS-DRG 018 (Chimeric Antigen Receptor T-cell Immunotherapy).   CAR T-cell therapies will no longer be eligible for new technology add on payments for FY2021. Procedure codes XW033C3 and XW043C3 are involved.

There is also a proposal to create new MS-DRGS 521 and 522, Hip replacement with PDX of hip fx with and without MCC.

There is another proposal to create  Pre-MDC MS-DRGs for cases with hemodialysis  done with pancreas/kidney transplant along with wo new MS-DRGs for kidney transplant with hemodialysis.

There are also proposed changes to reassign several procedures in existing MS-DRGs to other DRGS. They involve carotid artery stent procedures, epilepsy with neurostimulator, TMJ replacements with two new base DRGs, left atrial appendage closure (LAAC), insertion of cardiac contractility modulation devices.

ICD-10-CM Proposed Diagnosis Code Changes

There are 595 proposed changes for FY2021:  490 new codes, 47 revised codes and 58 deleted codes.  Below are just the highlights.

ICD-10-CM proposed code additions include:

  • Additional  D57 codes for more specified sickle-cell anemia
  • Additional codes for D59.1- autoimmune hemolytic anemias
  • D89 codes for cytokine release syndrome
  • Many new codes related to drug use and abuse (including alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, other psychoactive) with F10-F15 and F19 codes. (i.e., F10.120, Alcohol ABUSE with withdrawal, uncomplicated)
  • New G97.- codes for intracranial hypotension
  • Expanded list of H18 corneal dystrophy codes
  • Expanded M05, M06, M08, and M19 codes for both adult and juvenile rheumatoid arthritis and osteoarthritis
  • New M26.- codes for arthritis of temporomandibular joint
  • Expansion of N18.3- CKD stage 3a and stage 3b codes
  • Expanded R51 codes relating to headaches
  • Additional S20 codes for injuries to the thorax
  • Expanded T40 codes for poisoning, underdosing, and adverse effects of fentanyl, tramadol, and other synthetic narcotics
  • Roughly 120 new V00-V06 codes for electric scooter and other micro-mobility pedestrian conveyance injuries

ICD-10-CM proposed code deletions include:

  • Some H18 corneal dystrophy codes because of the proposed expanded additions
  • R51 because of proposed specified headache additions
  • Some T40 codes for poisoning due to proposed specified additions such as Tramadol and synthetic narcotics

ICD-10-CM proposed revised codes include:

There are several revised titles

  • Z68 codes relating to both adult and pediatric body mass index
  • Allergy status Z88 codes


Proposed MCC and CC Changes

Proposed MCC list changes include:

  • Addition of the proposed D57 codes for sickle cell anemia
  • Addition of U07.1 for COVID-19, which was already implemented on April 1, 2020
  • Addition of proposed P91.- neonatal cerebral infarction codes
  • Deletion of A84.8 for other tick-borne viral encephalitis, which was also a proposed ICD-10-CM deletion

Proposed CC list changes include:

  • Additions of proposed B60.- Babesiosis codes
  • Addition of the proposed F10-F15 and F19 codes related to drug use and abuse
  • Addition of the proposed T86 codes related to corneal transplants
  • Additions the proposed M80.- of age related and other osteoporosis with pathological fracture
  • Deletions of proposed deleted T86 codes being replaced by more specified codes for corneal transplant complications

ICD-10-PCS Proposed Procedure Code Changes

  • Many procedure codes were added to 02F, 03F and 04F with the addition of root operation “Fragmentation” to heart and great vessels,  upper and lower arteries and veins body systems. One example is 02FS3Z0, Fragmentation of right pulmonary vein, percutaneous approach, ultrasonic
  • Addition of drainage of pelvic cavity codes. One example is 0W9J70Z, Drainage of pelvic cavity with drainage device, via natural or artificial opening approach
  • Addition of other imaging of bile ducts with fluorescing agent, indocyanine green dye and other. One example is BF532ZZ, other imaging of gallbladder and bile ducts using fluorescing agent
  • Addition of Low does rate (LDR) brachytherapy codes in section D
  • New codes for introduction of Brexanolone, Nerinitide, Esketamine Hydrochloride and Eladocagene exuparvovec


The information contained in this post 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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