Posted on by Louri Roberts under Billing

Insurance Updates

Centers for Medicaid and Medicare Services (CMS)
CMS updated and released a draft of the National Coverage Determinations (NCD) Guidelines for the Alzheimer’s disease treatment drug, Aduhelm. The coverage limitations could create challenges for those seeking treatment. The NCD process began in July of 2021 and at the time, the drug was highly controversial, with some experts remaining skeptical, causing the Food and Drug Administration to withdrawal its approval. CMS is expected to finalize the NCD Guidelines by April 11, 2022.

CMS and the CDC (Centers for Disease Control and Prevention) released new ICD-10 codes that became effective April 1, 2022. Some of the new April 1 diagnosis codes include:

  • Z28.310 – Unvaccinated for COVID-19
  • Z28.311 – Partially vaccinated for COVID-19
  • Z28.39 – Other underimmunization status
  • Z28.0 – Underimmunized due to Contraindication
  • Z28.1 – Underimmunized due to reasons of belief or group pressure
  • Z71.85 – Encounter for immunization safety counseling

Guidelines state that “these codes should not be used for individuals who are not eligible for the COVID-19 vaccines, as determined by the healthcare provider.” There are also nine new ICD-10 procedure codes:

  • XW013V7 Introduction of COVID-19 vaccine dose 3 into subcutaneous tissue, percutaneous approach, new technology group 7
  • XW013W7 Introduction of COVID-19 vaccine booster into subcutaneous tissue, percutaneous approach, new technology group 7
  • XW023V7 Introduction of COVID-19 vaccine dose 3 into muscle, percutaneous approach, new technology group 7
  • XW023W7 Introduction of COVID-19 vaccine booster into muscle, percutaneous approach, new technology group 7
  • XW0DXR7 Introduction of fostamatinib into mouth and pharynx, external approach, new technology group 7
  • XW0G7R7 Introduction of fostamatinib into upper GI, via natural or artificial opening, new technology group 7
  • XW0H7R7 Introduction of fostamatinib into lower GI, via natural or artificial opening, new technology group 7
  • XW023X7 – Introduction of tixagevimab and cilgavimab monoclonal antibody into muscle, percutaneous approach, new technology group 7; (tixagevimab and cilgavimab monoclonal antibody or Evusheld is used for treatment of COVID-19, and is not a substitute for a vaccine)
  • XW023Y7 – Introduction of other new technology monoclonal antibody into muscle, percutaneous approach, new technology group 7

Other changed that became effective April 1, 2022 can be found here.

Resources:

https://healthpayerintelligence.com/news/national-coverage-determination-may-limit-access-to-ad-treatment?eid=CXTEL000000597475&elqCampaignId=24451&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=5bffbc0e3e024e97aa2147344ca34ea6&elq=fc80411a4c5f4004b03921ca0c8ccaed&elqaid=25273&elqat=1&elqCampaignId=24451
https://journal.ahima.org/page/new-icd-10-cm-pcs-codes-become-effective-april-1
https://www.outsourcestrategies.com/blog/cdc-announces-new-diagnosis-codes-effective-april-2022.html

About PGM

Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States.  For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories.  PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more.  PGM’s medical billing and practice management solutions include:                                –