Healthcare News: CMS provides guidance on NTAP for antimicrobial resistance

February 4th, 2020

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This CMS-focused article explains recent guidance on new technology add-on payments for hospital inpatients in the context of antimicrobial resistance. It covers the alternative NTAP pathway for innovative antibiotics, the need for procedure coding to identify qualifying technology on claims, and the update to diagnosis coding severity for antimicrobial resistance. The piece is relevant to hospital coders, inpatient billing staff, compliance teams, and anyone tracking CMS payment policy and code-set changes.

Why This Topic Matters

The article highlights policy and coding changes that can affect whether hospitals can report and receive add-on payment for certain inpatient technologies. It also notes a severity-level update for antimicrobial resistance diagnosis coding, which may affect inpatient case mix and claim processing.

Article Sections

  1. CMS guidance on NTAP and antimicrobial resistance

    Overview of CMS policy updates related to inpatient add-on payment for antimicrobial-focused technologies and the broader issue of antimicrobial resistance.

  2. Payment pathway and claim identification requirements

    Discussion of the alternate NTAP pathway and the claim-level procedure coding needed to identify qualifying technology for payment processing.

  3. ICD-10-CM severity update for resistance diagnoses

    Summary of the CMS update to the severity level designation for diagnosis codes associated with antimicrobial resistance.

  4. List of affected ICD-10-CM diagnosis codes

    Enumeration of the diagnosis codes referenced by CMS in connection with antimicrobial resistance reporting and severity classification.

What You Will Learn

  • How CMS is approaching NTAP policy for antimicrobial-related inpatient technologies
  • Why procedure coding is important for identifying qualifying technology on hospital claims
  • What type of diagnosis coding update CMS made for antimicrobial resistance
  • Which broad coding and billing stakeholders are most affected by the policy update

Who Should Read This

  • Hospital inpatient coders
  • Hospital billing staff
  • Revenue cycle teams
  • Compliance professionals
  • Healthcare reimbursement specialists
  • Clinical documentation improvement staff

Codes Discussed

  • ICD-10-CM: Z16.10
  • ICD-10-CM: Z16.11
  • ICD-10-CM: Z16.12
  • ICD-10-CM: Z16.19
  • ICD-10-CM: Z16.20
  • ICD-10-CM: Z16.21
  • ICD-10-CM: Z16.22
  • ICD-10-CM: Z16.23
  • ICD-10-CM: Z16.24
  • ICD-10-CM: Z16.29
  • ICD-10-CM: Z16.30
  • ICD-10-CM: Z16.31
  • ICD-10-CM: Z16.32
  • ICD-10-CM: Z16.33
  • ICD-10-CM: Z16.341
  • ICD-10-CM: Z16.342
  • ICD-10-CM: Z16.35
  • ICD-10-CM: Z16.39

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