What didn’t happen and what did: March C & M meeting highlights

March 18, 2022 / By Rhonda Butler

The March ICD-10 Coordination and Maintenance Committee (C&M) meeting, held via Zoom March 8 and 9, had 60 topics on the combined agenda—29 topics for proposed changes to the procedure classification and 31 topics for the diagnosis classification. Although the agenda was larger than most, it is normal for the March meeting to have many more topics to discuss than the September meeting, because of the various deadlines to submit change requests.

Before I talk about what did happen at the meeting, I want to share a small, remarkable thing I noticed that did not happen at the meeting—like when you’re out walking in the forest and you stop moving, because you are suddenly aware that it is perfectly silent. There were no COVID-19 topics at the meeting—no new diagnosis and procedure codes requested for COVID-19-related conditions and therapies. I found this non-event encouraging, and I hope you do too.

Below are summaries of a few procedure code topics I found interesting. The PDF of the procedure agenda is on the Centers for Medicare & Medicaid Services (CMS) website.

If you are more interested in the diagnosis code proposals, I can tell you, briefly, this: there was more discussion of social drivers of health (SDoH) codes, proposals specific to the pediatric population such as “impairing emotional outbursts” and “problems related to upbringing,” as well as additional detail proposed for Parkinson’s disease, Crohn’s disease, appendicitis with generalized peritonitis, anal fistula, hypertension, sinus tachycardia, and proposed new codes for a host of syndromes and congenital conditions.

The PDF of the diagnosis agenda is on the Centers for Disease Control and Prevention (CDC) website. If you have the time and stamina, the links to the full Zoom recording and passwords for both days of the meeting are on the CMS website as a downloadable PDF.

CMS process changes, spine hardware, computer-assisted diagnosis and treatment, and more

CMS continued the process changes made last year to accommodate the increasing number of proposals: 1) 13 new code proposals for therapeutic agents applying for add-on payment under the New Technology Add-on Payment (NTAP) program were included in the agenda but not discussed at the meeting; and 2) there was an assigned 15-minute time slot for the 16 topics on the agenda that were discussed at the meeting.

In addition, CMS announced the full launch effective March 1 of the new system called Medicare Electronic Application Request Information System™ (MEARIS). The new system is used for submitting formal ICD-10-PCS code change and MS-DRG change requests, among other things. The system can be accessed on the CMS website. For more detail, see page 13 of the agenda PDF.

More than half of the code proposals discussed at the procedure code session came from NTAP applicants, so most of the presentations focused on innovations in technology or software. Among those were new codes for three types of spine surgery hardware, as well as more codes for software applications.

• Posterior vertebral body tethering (page 22 of the PDF) describes a new vertebral body tethering system designed to prevent post-operative Proximal Junctional Kyphosis/Failure (PJK/PJF) in patients undergoing posterior spinal fusion, or patients who develop PJK/PJF after spinal fusion.
• Insertion of a posterior spinal motion preservation device (page 41) proposes new codes for an articulating titanium and polycarbonate device placed following extensive spinal decompression that includes partial/total facetectomy and is intended as an alternative to spinal fusion.
• Insertion of fenestrated sacropelvic fixation system (page 43) is a dual-purpose fixation screw which has surface characteristics that promote growth into the pores of the screw, and so it can be used to fuse the sacroiliac (SI) joint if placed in the sacroalar-iliac trajectory.

Two different software applications use computer modeling for decision support with percutaneous cardiac intervention (PCI) in the cardiac cath lab.

• Quantitative flow ratio (QFR) for non-invasive analysis of coronary angiography (page 57) analyzes standard X-ray coronary angiography to produce a 3D model of the vessel with QFR values along the vessel, and can be used before or during a PCI to inform decisions such as determining stent size.
• Simulation for assessment of coronary obstruction risk (page 66) analyzes cardiac CT scan data and creates a model and animated simulation of TAVR (transcatheter aortic valve replacement) for a particular patient and type of valve, for determining the risk that the procedure/valve will obstruct the adjacent coronary artery (a life threatening complication of the procedure).

Two other software applications propose to transform the effectiveness of existing modalities, one for treatment of depression and the other for detection of an epileptic seizure.

• Computer-assisted transcranial magnetic stimulation (TMS) of the prefrontal cortex (page 34 of the CMS agenda) uses a proprietary algorithm that analyzes MRI data to find the precise target for the magnetic pulses sent to the brain, to more effectively treat major depression in adults.
• Computer-aided analysis for the detection and classification of epileptic events (page 38) is a small patient monitoring system consisting of a computer, a camera and a microphone (no wearables) that analyzes audio and video data to identify and alert clinicians of possible seizure events in real time.

Three requestors asked CMS to reconsider the current classification for various reasons.

• Laser interstitial thermal therapy (LITT) (page 69)—the request is to move LITT codes from the Radiation Therapy section to the root operation Destruction in the Medical and Surgical section, because they believe this is a more accurate classification of the procedure.
• Cardiac Perfusion with Intra-arterial Supersaturated Oxygen (page 62)—in this case, the requestor asked that the current codes be deleted and replaced with something that makes the distinction between this procedure and hyperbaric oxygen treatment clearer.
• Ex vivo autologous hematopoietic stem cell gene therapy (page 53)—the request is for specific codes for each formulation of a stem cell-based gene therapy, because each one is used to treat a different disease.

If you would like to comment on any of the code proposals, the email addresses and deadlines are as follows:

For procedure code proposals, send comments by April 8, 2022, to CMS at ICDProcedureCodeRequest@cms.hhs.gov .

For diagnosis code proposals, send comments by May 9, 2022, to NCHS/CDC at nchsicd10CM@cdc.gov.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.