CMS Releases New ICD-10 PCS Codes

Final ICD-10-PCS codes for FY 2020 are here.

The Centers for Medicare & Medicaid Services (CMS) released the final FY 2020 ICD-10-PCS codes on May 31. This included a total of 77,559 procedure codes for the MS-DRG V37.   

The changes include 734 new codes, 2,056 deleted codes, and two revisions. The proposed rule predicted a net change of 1,660 fewer procedure codes, but the final rule only reduced the classification by 1,222.

Examples of the new procedures that can be captured include the following:

• Bypass, cerebral ventricle to subgaleal space
• Bypass, descending/ascending thoracic aorta to innominate artery
• Insertion of intraluminal/other device into coronary artery (arteries)
• Supplement of coronary arteries
• Bypass of innominate, subclavian, axillary, brachial arteries to lower extremity vein
• Bypass of ulnar artery to lower arm vein
• Restriction of various vessels using an intraluminal device, flow diverter
• Occlusion of gastric vein
• Supplement of mastoid, maxillary, frontal, ethmoid, and sphenoid sinuses
• Bypass of small/large intestine
• Extraction of breast
• Replacement of skin with cell suspension technique
• Insertion/removal of subcutaneous defibrillator lead
• Extirpation of matter from jaw
• Transfusion of related/unrelated T-cell depleted hematopoietic stem cells
• Irrigation of joints
• Monitoring of lymphatic flow
• Intraoperative Extracorporeal Membrane Oxygenator (ECMO)
• Fluorescence guided procedure
• Low dose rate brachytherapy using a unidirectional source

Many of these new procedures were cited in the proposed rule. The code for bypass of the small or large intestine provides an opportunity to decrease queries, when the specific portion of the intestine has not been identified for the bypass procedure. According to the National Library of Medicine, the flow diverter intraluminal stent “represents a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked, and fusiform. The highly dense mesh of these stents reduces inflow and outflow inside the aneurysm, resulting in intra-aneurysmal thrombosis and stent endothelialization.”

The New Technology section added the following:

• Dilation of lower extremity arteries with sustained release drug-eluting device
• Cerebral embolic filtration
• Monitoring kidney with fluorescent pyrazine
• Introduction of various new substances
• Measurement of infection

These are a predictor of procedures/services/substances that have been approved for the New Technology Add-On Payment (NTAP). The final rule will confirm which items have been approved for NTAP.

The deletions included breast procedures with an external approach. All procedures that were done on the bifurcation of vessels (arteries and veins) were removed throughout the Arteries and Veins sections.    The proposed rule identified 128 transfusion procedures that were clinically invalid, when the transfusion was performed at the artery. The final rule carried through with the deletions. The two revisions were an adjustment of Andexanet Alpha to inactivated coagulation factor Xa.

There was one adjustment in root operation (Character 3) definitions. The root operation “Control” had “the site of the bleeding is coded as an anatomical region and not to a specific body part” removed from its definition. The New Technology section added the root operations of Dilation and Measurement.

There were three changes to Body Part (Character 4). A tibioperoneal trunk was added as a definition for popliteal artery. A new value of “Skin, Chest” was added with the definition of procedures performed only on the skin of the breast. Submandibular space is an additional definition provided for Face Subcutaneous Tissue and Fascia.

There were new devices (Character 6) in the Medical and Surgical section, including internal fixation devices for intramedullary limb lengthening, flow diverter embolization device, CivaSheet, and subcutaneous defibrillator lead. Two new substances were added to the Administration section: types of anti-infective envelopes and Antibacterial Envelope (TYRX) (AIGISRx) and TYRX Antibacterial Envelope. The New Technology section added many new substances, for example, the CONTEPO Intraluminal Device Sustained Release Drug Eluting. 

The Index and Tables were updated based on the new codes that were adopted. There are too many tables that were updated to list. It is suggested to review the addendum files that are attached to the URL listed as the resource for this article.  

The next steps are to provide education to the inpatient coders, clinical documentation integrity professionals, and physicians; update the facility-specific guidelines; identify which new technology items are utilized, and review the documentation associated with the new procedures and new technology items.

Ready, set, go! FY 2020, here we come! 

Resources:

https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.html

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