While it May Not Have Been Love at First Sight, Coding Experts are Finding Their ICD-10 Groove

By Jodi Stewart, Vice President Revenue Integrity Services | August 17, 2018



We’re finally hitting a rhythm, finding our comfort zone, and there’s no longer any need to stress about what’s around the corner.  The fiscal year (FY) 2019 ICD-10-CM/PCS code sets have relatively minimal revisions. Good news!

Over the last few years, coding experts may have felt like they were working with an updated code set that was challenging.  There have been numerous updates within the Official Coding Guidelines (for example, Excludes1 exceptions and clarification of the word “with” in the Alphabetic Index), root operations, and their associated definitions have been updated (“Control”).

Further, payment associated with the Medicare Severity Diagnosis Related Groups (MS-DRG) have gone through continuous massaging.  For example, ICD 10 PCS code 0B9J8ZX (Drainage of left lower lung lobe, via natural or artificial opening endoscopic, diagnostic, which do not require resources of an operating room) received surgical weight in MS-DRG version 35, but then was designated as a Non O.R. Procedure in version 36.

In addition, the actual code sets have gone through significant updates over the last few years.  The majority of revisions with the ICD-10-CM code set occurred within the fiscal year (FY) 2017 update with 1,974 new codes, 425 revised codes and 311 deleted codes.



The majority of revisions with the ICD-10-PCS code set occurred within the FY 2018 update with 3,562 new codes, 1,821 revised codes and 646 deleted codes.



This year, there are few revisions for FY 2019 as compared to previous years. The majority of the ICD-10-CM codes occur in the following chapters:

  • Chapter 2 Neoplasms (45 new codes)
    • Expansion to differentiate between upper/lower eyelid
  • Chapter 7 Diseases of the Eye and Adnexa (43 new codes)
    • New codes to add specificity of the upper/lower eyelid with the sixth character
      • A = right eye, upper and lower eyelids
      • B = left eye, upper and lower eyelids
      • C = bilateral, upper and lower eyelids
  • Chapter 19 Injury, Poisoning and Certain Other Consequences of External Causes (54 new codes and 87 revised codes)
    • Addition of poisoning codes to include ecstasy
    • Addition of adult and child sexual/labor exploitation
    • Expansion of the infection following a procedure to describe the type of incision associated with the infection such as a superficial, deep incisional or organ and space surgical site
    • Addition of sepsis following a procedure


The bulk of the revisions within the ICD-10-PCS code set take place in the Medical and Surgical section with 383 of the 392 new codes located in that section.  Within the Medical and Surgical section, the majority of the added codes are located in the upper arteries and upper veins tables which now include qualifier “1” to identify the use of a drug-coated balloon as the 7th character qualifier.

There are minimal updates to the Official Coding Guidelines.  As an example, the ICD-10-CM guidelines related to documentation provided by clinicians other than the patient’s provider have been clarified.  In addition, the ICD-10-PCS guideline B.6.1a has been expanded to note, “If a device that is intended to remain after the procedure is completed requires removal before the end of the operative episode in which it was inserted (for example, the device size is inadequate or a complication occurs), both the insertion and removal of the device should be coded.”

For all the details on the FY 2019 ICD-10-CM/PCS updates, please plan to attend VitalWare’s webinar September 5th at 10am PT.  You can register here.