Change is Coming to the ICD-10-PCS Code Set for Fiscal Year 2020

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Fortunately, the changes should be easy to do with regards to the ICD-10-PCS code set which has already been released. Below is a summary of the changes by body system/section followed by the important changes to the official coding guidelines.

Effective for dates of service on or after October 1, 2019, the ICD-10-PCS code set will contain 77,559 total codes (down from 78,881 for FY 2019). The changes include 734 new codes, 2,056 deleted codes and 2 codes with revisions.

Code Changes

  • Nervous System – There are 9 new procedure codes which will allow for reporting bypass of the cerebral ventricle to the subgaleal space.
  • Heart and Great Vessels – New codes have been created to report bypass of the thoracic aorta to the innominate artery and insertion of intraluminal or other device(s) into the coronary arteries. In addition, the coronary arteries have been added as body parts for the root operation of Supplement.
  • Arteries and Veins – There are multiple new codes to describe bypass procedures to the lower extremity veins including bypass of the innominate artery, subclavian arteries, axillary arteries, brachial arteries, radial arteries and ulnar arteries. New codes have also been created to capture restriction of intracranial, carotid and vertebral arteries using an intraluminal flow diverter stent, which is used in the treatment of complex aneurysms. Additionally, occlusion of the gastric vein performed via natural or artificial opening can be reported as of 10/1/2019. The qualifier of Bifurcation was removed from the root operations of Dilation, Extirpation and Restriction throughout the code set, resulting in the deletion of 1,845 ICD-10-PCS codes.
  • Ear, Nose and Sinus – 165 new codes have been added to the root operation of Supplement. New body parts added for this root operation include the mastoid sinuses, accessory sinuses, maxillary sinuses, frontal sinuses, ethmoid sinuses and sphenoid sinuses.
  • Gastrointestinal – There are 144 new codes that will allow coders to report bypass of the small and large intestine when the specific segment of intestine involved is not documented in addition to 2 new codes for transfer of the large intestine to the vagina.
  • Skin and Subcutaneous Tissue – Breast is a new body part which is available under the root operation of Extraction. There is also a new qualifier of Cell Suspension Technique that has been added to the root operation of Replacement. A new device has been added to the root operations of Insertion, Removal and Revision to allow for reporting of Subcutaneous Defibrillator Leads. Finally, the external approach was removed for the breast procedures, which resulted in the deletion of 83 codes.
  • Musculoskeletal – A new device character of Intramedullary Limb Lengthening Internal Fixation Device has been added to the root operation of Insertion that may be assigned for the body parts of right and left humeral shaft, right and left femoral shaft, and right and left tibia. Additionally, the upper and lower jaw have been added as body parts when the root operation of Extirpation is performed in the General Anatomical Regions.
  • Administration – A new substance of T-cell Depleted Hematopoietic Stem Cells is being added for infusion into both peripheral and central veins. There is also a new code to capture introduction of hyperthermic antineoplastic agents into the peritoneal cavity. There are 128 procedure codes scheduled for deletion in the root operation of Transfusion as these were identified as clinically invalid procedures into the artery.
  • Measurement and Monitoring – A new qualifier has been added to report monitoring of lymphatic flow using Indocyanine Green dye.
  • Extracorporeal or Systemic Assistance and Performance – There are 3 new codes to capture intraoperative ECMO services.
  • Other Procedures – 17 new codes have been added to this section to capture fluorescence guided procedures.
  • Radiation Therapy – There are 80 new codes to allow for reporting of low dose rate brachytherapy using a unidirectional source.
  • New Technology – There are new procedure codes to capture dilation of lower extremity arteries using a sustained release drug-eluting device; cerebral embolic filtration; monitoring of the kidneys using fluorescent pyrazine; introduction of various new antineoplastic, anti-infective and enzyme inhibitor substances; and whole blood nucleic acid-base microbial detection.

Changes to Official Coding Guidelines

  • A new section for Radiation Therapy Guidelines has been inserted as Section D in response to public comment. This resulted in the New Technology Section Guidelines being moved from Section D to Section E. The New Technology Section Guidelines have also been revised to include a new section, E1.b, that describes correct reporting of multiple procedures when new technology procedures are involved.
  • The Body System guidelines in section B2.1a have been revised as a result of an adjustment to the root operation definition for Control. Specifically, “the site of bleeding is coded as an anatomical region and not to a specific body part” has been removed from the definition of Control.
  • The Root Operation Guidelines have several changes for FY 2020. An exception was added to Guideline B3.1b to clarify that two root operations are necessary to fully report mastectomy followed by breast reconstruction. Additionally, Guideline B3.5 was updated by adding the root operation of Extraction to the guideline governing procedures performed on overlapping layers of the musculoskeletal system. Verbiage was also added to Guideline B3.9 which outlines an exception to the rule governing excision for graft. The guideline now clarifies that a separate procedure is not coded when the seventh character value in the ICD-10-PCS table fully specifies the site from which the autograft is obtained.
  • The Body Part Guidelines were also updated. A third example has been added to Guideline B4.1b to clarify procedure sites that are qualified with “peri”.

More information is available from CMS.