Turn to Xcenda to develop and implement strategies to support appropriate coding and reimbursement.

Having a coding strategy for a new launch is a critical but sometimes overlooked piece of any commercialization plan. Our team of certified professional coders (CPCs) and coding experts helps manufacturers understand current codes related to their products and associated services, evaluate different coding options, and provide support, if needed, with new code applications. Xcenda’s coding analyses provide clients with a deeper understanding of the tactics, dynamics, and impact that coding can have on reimbursement throughout the life of a product. We provide our clients with evidence-based strategic insights around coding and code application submission for enhanced product access.

Our expertise includes:

Product and Related Services Coding

For products, Xcenda CPCs analyze available codes within the Healthcare Procedure Code System (HCPCS) codes and National Drug Codes (NDCs) and identify those that may be appropriate for use by providers to report the product at launch and at the multiple post-launch stages. For associated services, our team analyzes and identifies appropriate codes within the Current Procedural Terminology (CPT) and International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM) and ICD-10 Procedure Coding System (ICD-10-PCS) code sets. Other code sets specific to certain sites of care are also examined (eg, Medicare Severity Diagnosis Related Group (MS-DRG) codes applicable within the hospital inpatient setting, Ambulatory Payment Classification (APC) codes applicable within the hospital outpatient setting). Timelines, potential pros/cons, and process challenges of using miscellaneous codes vs established permanent codes are also identified, as well as the impact of shared vs specific codes when applicable. Coding nuances are detailed by payer (eg, Medicare, Medicaid, managed care) in the various sites of care (eg, hospital inpatient and outpatient, ambulatory care center, physician office, pharmacy, end-stage renal disease facility, home health, durable medical equipment supplier).

Diagnosis Coding

Xcenda analyzes and identifies appropriate ICD-9-CM and ICD-10-CM diagnosis codes for the product’s FDA-approved indications.

New Code Applications

In the event that new codes are necessary to report the product, related services, and/or diagnosis, Xcenda supports clients in different capacities, such as providing insights to the AMA and CMS HCPCS Workgroup requirements, key considerations, and processes for new code assignment.

  • Laying out tactics and a detailed timeline for key submission components
  • Assisting with preliminary code inquiries and completion of new code applications
  • Attending workgroup meetings to support new applications