Add-On Payments for New Technology

on Wednesday, 06 November 2013. All News Items | Coding

If your hospital performs a procedure involving services approved for a new technology add-on payment, are you getting the money you deserve? The 2014 IPPS Final Rule included add-on payments for several new technology drugs and procedures when performed on hospital inpatients. Providers should include the appropriate procedure, diagnosis, and/or drug codes for these services in order to receive the additional payments.

1). Glucarpidase (Voraxaze®)—treats patients who have been diagnosed with toxic methotrexate (MTX) concentrations as a result of renal impairment. It causes a rapid, continuous reduction of MTX concentrations. The procedure code necessary to report this drug is (00.95). The maximum add-on payment is $45,000 per case.

2). DIFICID™ (Fidaxomicin)—an oral antibiotic tablet that works against Clostridium-Difficile associated diarrhea (CDAD). DIFICID cases are reported with diagnosis code (008.45) to capture the Clostridium-Difficile infection in combination with the National Drug Code (52015-0080-01). Both the diagnosis and NDC codes must be reported on the 837i Health Care Claim Form. The maximum add-on payment is $868.

3). Zenith Fenestrated Abdominal Aortic Aneurysm (AAA) Endovascular Graft®—treats patients who have an AAA but are anatomically unsuitable for treatment with current endovascular grafts due to their infra-renal aortic neck being too short. The procedure code necessary to report the graft is (39.78). The maximum add-on payment is $8,171.50.

4). Argus® II Retinal Prosthesis System—treatment for patients with Retinitis Pigmentosa that have little or no light perception in either eye. The system consists of an implant (epiretinal prosthesis), an external component, and a fitting system. The procedure code necessary to report the prosthesis is (14.81). The maximum payment is $72,028.75.

5). Zilver® PTX® Drug-Eluting Peripheral Stent—treatment of peripheral arterial disease of the superficial femoral arteries. The stent is coated with Paclitaxel, a drug that treats patients with advanced forms of cancer. The procedure code necessary to report the stent is (00.60). The maximum add-on payment is $1,705.25.

6). Kcentra™--a replacement therapy for fresh frozen plasma (FFP) for patients with an acquired coagulation factor deficiency due to Warfarin and who are experiencing a severe bleed. The procedure code necessary to report this drug is (00.96) (Infusion of 4-Factor Prothrombin Complex Concentrate). The maximum add-on payment is $1,587.50.    

Article by Susie James

Susie James, RHIT, CCS, AHIMA-approved ICD-10-CM/PCS Trainer, is the Manager of Inpatient Coding Services at MMP.   Susie has worked in the coding field for over twenty-seven years and previously worked for a large multi-facility system in Birmingham. Susie is currently serving as the President of the Alabama Association of Health Information Management (AAHIM) on the Board of Directors.   Susie is also a member of the American Health Information Management Association (AHIMA). She currently serves as a member of AHIMA’s Envisioning and Collaborative Team and recently served as a facilitator at AHIMA’s 85th National Convention in Atlanta, GA. Susie has served as an AAHIM delegate at the National AHIMA Conventions in Orlando, Florida in 2010, Salt Lake City, Utah in 2011, Chicago, IL in 2012, and Atlanta, GA, in 2013. You may contact Susie at This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.

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