Q: CMS created a new MS-DRG for chimeric antigen receptor T-cell (CAR-T) therapies in the fiscal year (FY) 2021 IPPS final rule. Which ICD-10-PCS codes group to this new MS-DRG and does it qualify for an additional new technology add-on payment?
A patient with a history of hypertension sees a cardiologist for chest discomfort during exercise. The cardiologist completes an office visit and performs a cardiac stress test the same day. Would it be appropriate to report the visit using an E/M code with modifier -25?
Q: We are having trouble with a case that involves an Implantation of a cardiac resynchronization therapy-pacemaker (CRT-P) with three leads and an envelope since our facility is new to using pacemaker envelopes. How should this procedure be reported in ICD-10-PCS?
Q: During an outpatient visit, a nurse reviews the patient’s medical history and a physician performs an examination in the presence of the nurse. If you adhere to the 2021 E/M guidelines and use time as the controlling factor for code selection, can you report one E/M code for these shared services?
Q: When would it be appropriate to report modifier -58 (staged or related procedure or service by the same physician during the postoperative period) for a procedure performed during the postoperative period?
Q: When is it appropriate to report both flash or acute pulmonary edema and acute on chronic heart failure (diastolic, systolic, or other) in ICD-10-CM? What other etiologies lead to flash pulmonary edema and how do I know when to query?
