New Technology ICD-10-PCS Section “X” Drugs for FY2019

Section “X” is a separate place within ICD-10-PCS for certain new technology procedures (such as new technology drugs). Section “X” does not introduce any new coding concepts or unusual guidelines for correct coding and maintains continuity with the other sections in ICD-10-PCS. The same root operation and body part values are used in section “X” as in other sections. The seventh character in section “X” is used to indicate the new technology group. This is a number or letter that changes each year that new technology codes are added. It is only used to indicate the year the code was created and all codes for that update year will have the same qualifier. The new technology drugs for FY2019 will have the qualifier/seventh character of “4” since this is the third year of ICD-10-PCS.

 

Section “X” codes are standalone codes. No additional codes from other sections in ICD-10-PCS are necessary for reporting as the specific procedure is described in the code title from section “X”.

New Technology section codes are easily found by looking in the ICD-10-PCS Index or the Tables. The name of the new technology device, substance or technology for a section “X” code is included as the main term. They are also listed under the main term “New Technology”.

New technology items have a new technology payment that is made in addition to the DRG payment for hospital inpatients.  Missing new technology codes is a frequent error made by coders.  Coders must familiarize themselves with the new technologies of each year.

 

There are several substance values continuing in the code table XW0 (anatomical regions, introduction) for FY2019.

• A—Bezlotoxumab Monoclonal Antibody/ZINPLAVA™ (XW033A3, XW043A3) The maximum a hospital can received for this is $1,900 as new technology payment.
• B—Cytarabine and Daunorubicin Liposome Antineoplastic/VYXEOS™ (XW033B3, XW043B3) The maximum the hospital can receive for this is $36,425 as a new technology payment.
• C—Engineered Autologous Chimeric Antigen Receptor T-Cell Immunotherapy/KTE-C19/axicabtagene ciloleucel/CAR-T therapy (XW033C3, XW043C3) The maximum payment a hospital can receive for this is $186,500 as a new technology payment
• F—Ustekinumab/STELARA™ (XW033F3, XW043F3) The maximum the hospital can receive for this is $2,400 as a new technology payment.
• 9—Defibrotide sodium/DIFETELIO® (XW03392, XW04392) The maximum the hospital can receive for this is $80,500 as a new technology payment.

 

There were five new substance values added to the code table XW0 (anatomical regions, introduction) for FY 2019.

• C—Axicabtagene Ciloleucel/YESCARTA™ and Tisagenlecleucel/KYMRIAH (XW033C3, XW043C3) These are two new CAR T therapies for FY2019.   The maximum payment a hospital can receive for this is $186,500 as a new technology payment
• G—Plazonmicin/ZEMDRI™ (XW033G4, XZW043G4)  The maximum a hospital can receive for this is $2,722.50 as a new technology payment.
• H—GIAPREZA™ (XW033H4, XW043H4)  The maximum payment a hospital can receive for this is $1,500 as a new technology payment.
• D—Meropenem-vaborbactam/VABOMERE™  (XW033F3, XW043F3 – there is no unique code for VABOMERE) For FY 2019, cases “eligible for the FY 2019 new technology add-on payments will be identified by the NDC of 65293-009-01 (VABOMERE™ Meropenem-Vaborbactam Vial). Providers must code the NDC in data element LIN03 of the 837i Health Care Claim Institutional form in order to receive the new technology add-on payment for procedures involving the use of VABOMERE™” The maximum payment a hospital can receive for this is $5,544 as a new technology payment.
• 7—Andexanet alfa/AndexXa™  (XW03372, XW04372)  AndexXa is a newer form of Andexanet Alfa. The maximum payment a hospital can receive for this is $14,062.50 as a new technology payment.

 

New Technology Drugs for 2018 – 2019

AndexXa™ (Andexanet alfa)

is an antidote used to treat patients who are receiving treatment with an oral Factor Xa inhibitor who suffer a major bleeding episode and require urgent reversal of direct and indirect Factor Xa anticoagulation. Patients at high risk for thrombosis, including those who have been diagnosed with atrial fibrillation (AF) and venous thrombosis (VTE), typically receive treatment using long-term oral anticoagulation agents.

Axicabtagene Ciloleucel (YESCARTA™) and Tisagenlecleucel (KYMRIAH™).

(Fights non-Hodgkin’s Lymphoma and Acute Lymphoblastic Leukemia) For these CAR T-Cell therapies. Both are given IV.

Bezlotoxumab (ZINPLAVA™)

—this drug is used in patients with Clostridium difficile (C. diff) diarrhea who are already on antibiotics and have a high risk of recurrence. Up to 25% of patients with C. diff will have a recurrence of the bacteria. Use of this drug helps to reduce recurrence of the bacteria. This drug is a human monoclonal antibody targeting the C. diff toxin B and does not affect the GI microbiota like the antibacterial drugs do. This drug is administered by IV.

Cytarabine/ and Daunorubicin (VYXEOS™)

—this drug is used in patients with newly diagnosed therapy related acute myeloid leukemia (t-AML) or AML. VYXEOS delivers and maintains fixed ratios of Cytarabine and Daunorubicin and provides prolonged exposure in the bone marrow. Both Cytarabine and Daunorubicin are existing chemotherapy drugs and are commonly used but VYXEOS is a specific formula of the two drugs. This is administered by IV.

Defibrotide sodium (DEFITELIO®)

is treatment for patients diagnosed with hepatic veno-occlusive disease (VOD) with evidence of multiorgan dysfunction. Also known as sinusoidal obstruction syndrome.  This is a life threatening complication of hematopoietic stem cell transplantation (HSCT).  Treatment is  25 mg/day for 21 + days.

Engineered Autologous Chimeric Antigen Receptor T-Cell Immunotherapy/KTE-C19/axicabtagene ciloleucel/CAR-T therapy

—this engineered autologous immunotherapy is used to treat patients with relapsed or refractory B-cell non-Hodgkin lymphoma who are eligible for an autologous stem cell transplant. This represents a new paradigm in antineoplastic therapy. In this, the patient’s own T-cells are harvested and engineered to target specific antigens. After this is infused back into the patient, the genetically engineered T-cells find the target cells and kill them.

GIAPREZA™

a synthetic human angiotensin II, is administered through IV infusion to raise blood pressure in adult patients who have been diagnosed with septic or other distributive shock.

Neropenem-vaborbactam (VABOMERE™)  

Given IV for adults with complicated UTIs and acute pyelonephritis (chills, rigors, temp higher than 38C, WBC over 10,000, etc.)

Plazonmicin (ZEMDRI™) 

Next generation aminoglycoside antibiotic to treat multi-drug resistant gram-negative bacteria, usually complicated UTI (cUTI) or pyelonephritis. It is given IV.

Ustekinumab (STELARA™)

is an IV infusion treatment for Crohn’s disease. Only for use in patients over 18 with moderately to severely active Crohn’s disease.

References
AHA ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2018 Page 56
medpagetoday.com/cardiology/prevention/72701cancer.gov/publications/dictionaries/cancer-drug/def/autologous-cd19-cd22-chimeric-antigen-receptor-t-cells
merckconnect.com/zinplava/overview.html
fda.gov/NewsEvents/Newsroom/PressAnnouncements
cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page-Items/FY2019-IPPS-Final-Rule-Regulations.html

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