- Although anticipated sweeping ICD-10 coding updates did not occur this year, new codes for medical technology should be reviewed.
- New technologies include devices for treating aneurysms, performing transfusions and navigating lymph node biopsies.
Every October, ICD-10-CM and ICD-10-PCS provide updates for the upcoming fiscal year, and this year was no different. There was a lot of hype in the proposed changes that implied there would be sweeping updates to the complication/comorbidity and major complication/comorbidity lists. These were intended to be mostly downgrades. In fact, there were to be approximately 1,400 severity changes that would have a significant impact on payment. Public comment was tremendous, so these changes were delayed because of the magnitude of the revisions. Who knows what will happen next year? Keep your eyes and ears open.
This leads to less significant coding updates for 2020. But rather than focus on what might have been, the following are ICD-10-PCS codes for new technology to assist with proper payment.
1. Flow diverter device. This is a new ICD-10-PCS device character under root operation “restriction,” and it is used to treat non-ruptured intracranial aneurysms. There are two brand names currently on the market that have FDA approval: Stryker’s Surpass Streamline Flow Diverter and Pipeline Flex embolization device manufactured by Medtronic.
This device is implanted into the parent blood vessel from where the aneurysm is located. Rather than placing a device inside the aneurysm, as is done with coiling, this device diverts blood flow away from the aneurysm itself. While this technology may appear similar to a traditional vascular stent, these devices have a significantly higher mesh density, which prevents flow in the parent artery from entering the aneurysm, thus eliminating the need for a coil. The risk of rupturing the aneurysm during surgery is greatly diminished by not placing a device inside the aneurysm.
2. T-cell depleted allogeneic hematopoietic stem cell transplant. This is a new ICD-10-PCS substance character under root operation “transfusion.” This type of transplant is performed in patients with high-risk cytogenetics and/or relapsed multiple myeloma. It is expected that this procedure can reduce or prevent acute and chronic graft versus host disease (GVHD) in both human leukocyte antigen (HLA) matched and haplotype disparate hosts, without post-transplant prophylaxis with immunosuppressive drugs.
GVHD remains one of the leading causes of morbidity and mortality associated with conventional allogeneic hematopoietic stem cell transplantation (HCT). In simple terms, the functional immune cells in the transplanted graft recognizes the recipient as “foreign” and mounts an immunological attack that usually takes place within the first 100 days after the transplant. The use of T-cell depletion significantly reduces this complication.
3. Indocyanine green dye. This is a new ICD-10-PCS qualifier character under root operation “monitoring of physiologic systems.” Although this technology is not new, it does have a new use. It is being used to help navigate sentinel lymph node biopsies. Sentinel lymph nodes are the hypothetical first lymph node or group of lymph nodes that a primary cancer would metastasize to. Previously, the indocyanine green dye (a true fluorescent green dye) was used for assessing cardiac function and hepatic function and with ophthalmic angiography. Its advantage is that it allows for imaging of deeper patterns of circulation than fluorescein angiography. It is simple, radiation-free and has an uncomplicated application.
4. Aminolevulinic acid. This is a new ICD-10-PCS qualifier character under root operation “other procedures” in the “head and neck” body region. Aminolevulinic acid is used to treat actinic keratosis (small crusty or scaly bumps that result from exposure to sunlight and can lead to skin cancer) and advanced head and neck squamous cell carcinoma. It is used in combination with a special blue light/photodynamic therapy not to be confused with a laser. The light is used to activate the drug and is typically used only on the face or scalp.
5. Unidirectional source for brachytherapy using palladium 103. This is a new ICD-10-PCS isotope and qualifier character under modality brachytherapy. The radioactive element called CivaSheet is the only FDA-cleared, unidirectional, planar brachytherapy source. The device is applied intraoperatively during tumor resection used for difficult to reach cancer sites.
One of the unique features of the device is that it has an active (delivers the brachytherapy/palladium-103) and an inactive (gold shielding) side. The active side delivers a full dose of radiation to surgical margins, while radio-sensitive and healthy tissues on the inactive side are shielded from unnecessary and potentially harmful radiation. This configuration means that clinically effective doses of radiation can be delivered without toxicity to adjacent tissues. This provides an alternative to external beam radiation, particularly in patients that have already received maximum doses from prior radiation treatments.