September 30, 2014

Partial code set freeze would continue with regular updates beginning October 2016

By Betty A. Hovey, CPC, CPC-H, CPB, CPMA, CPC-I, CPCD

The ICD-10 Coordination and Maintenance (C&M) Committee is a public forum for the presentation of proposed modifications to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and ICD-10 Procedure Coding System (ICD-10-PCS).

The committee is responsible for approving coding changes, developing errata, addenda and other modifications. At the meetings, presentations are given that describe the clinical aspect of the disease, the procedure, or the technology. Then, proposals are offered on code additions, revisions, and deletions surrounding the subject. Next, participants at the meeting are able to ask questions and/or make comments and recommendations regarding the clinical or coding issues. No final decisions are made at the meetings.

The most recent C&M meeting was held this past week, September 23 and 24th at the CMS Building in Baltimore, Maryland. I had the privilege of attending this meeting live and would like to share some of the highlights.

General Announcements/Issues

Throughout the meeting, some general issues were addressed. First of all, an announcement was made confirming that the partial code set freeze would continue with regular updates to ICD-10 to begin on October 1, 2016. There will be no new codes added in ICD-9-CM, ICD-10-CM, or ICD-10-PCS for 2015.

An update for the ICD-10 MS-DRGs was also given. In November, the following will be available at www.cms.gov/Medicare/Coding/ICD10/ICD-10-MS-DRG-Conversion-Project.html:

  • The ICD-10 MS-DRG V32.0 Definitions Manual will be available in text and HTML versions
  • The ICD-10 MS-DRG V32.0 "Summary of Changes"
  • The ICD-10 Definitions of Medicare Code Edits

Medicare ICD-10 testing was also discussed at the meeting by Stacy Shagena of CMS. She reported that CMS is taking a four-pronged approach to ensure that CMS and the provider community is prepared. This includes the following:

  • CMS internal testing of its processing system, which was completed in October of 2013
  • Beta testing tools
  • Acknowledgement testing, with the first testing week performed successfully in March of 2014
    • More than 127,000 claims were submitted
    • Approximately 2,600 providers, suppliers, billing companies, and clearinghouses participated
    • Nationally, 89% of the test claims were accepted, with some regions as high as 99% acceptance
  • End-to-end testing, which will be offered January, April, and July of 2015
    • 50 volunteers to be chosen by each MAC to provide a representative sample of submitters
    • Each volunteer will be allowed to submit 50 test claims
    • Volunteers will be able to submit 50 additional claims in subsequent testings without re-registering

Ms. Shagena announced that anyone may submit acknowledgement tests claims anytime until October 1, 2015. There will be special testing weeks that will give submitters access to live help desk support and will allow CMS to gather and analyze testing data. The testing weeks are November 17-21, 2014; March 2-6, 2015; and June 1-5, 2015 with no registration required.

ICD-10-PCS Requests

There were six main topics of discussion for the ICD-10-PCS portion of the meeting: hip and knee replacements and procedures, minimally invasive cardiac valve surgery, drug-coated balloon angioplasty, face transplants, hand transplants, and administration of Ceftazidime-Avibactam.

Dr. Karl Koenig from New Hampshire gave clinical information on different types of partial hip replacements, hip resurfacing, unicondylar knee replacements, and patellofemoral joint procedures. Requests were made to add specificity in some cases, and to move the procedures to different root operations tables in others. There was also a request made to add new body part values for table 0SP, Removal from Lower Joints, for acetabular, femoral, tibial, and patellar surfaces to provide additional, more specific information on the procedure performed.

Next, Dr. Francis Duhay led the discussion on minimally invasive cardiac valve surgery. Currently in ICD-10-PCS, there is no way to indicate that a procedure was performed by minimally invasive technique. A request was made to add a way to report a separate technique for minimally invasive cardiac surgery to indicate the unique patient effects, hospital resource use, and physician skills and expertise required. Three options were presented, including to change nothing, to add two qualifiers to indicate right thoracotomy and mini-sternotomy, and to add a new approach.

Dr. Michael Jaff spoke on a request for adding a way to identify the use of drug-coated balloons used in peripheral angioplasty. This is not considered a device in ICD-10-PCS as the balloon is not left in when the procedure is completed. Options offered include adding a qualifier for drug-coated balloon to all vessels in table 047, Dilation of Lower Arteries, and adding the qualifier to only the femoral and popliteal artery Body Parts.

Pat Brooks from CMS introduced Dr. Steve Phurrough who spoke on the request from the Department of Defense (DOD) for ways to capture face and hand transplants, both of which are still considered experimental. Currently face transplants are coded to Replacements of the individual parts of the face that are transplanted and hand transplants are currently coded to Repairs of the hand(s). Requests were made to add specific tables for Transplants of the specific Body Parts of hand and face. CMS supports these requests.

Finally, Tavis Cooper, Pharm. D spoke on Forest Lab’s request to add a new way to capture intravenous administration of ceftazidine-avibactam. This is used to treat patients with complicated urinary tract infections, complicated intra-abdominal infection, and aerobic Gram-negative infections with limited treatment options.

ICD-10-CM Requests

There were 19 new ICD-10-CM additions requests, along with Tabular and Index Addenda. These were:

  • Castleman Disease
  • National Institutes of Health Stroke Scale
  • Cryopyrin-Associated Periodic Syndromes and Other Autoinflammatory Syndromes
  • Dental Terms
  • Mastocytosis and Certain Other Mast Cell Disorders
  • Dyspareunia
  • Incontinence
  • Difficulties with Micturition
  • Irritable Bowel Syndrome with Constipation
  • Chronic Idiopathic Constipation
  • Observation and Evaluation of Newborns for Suspected Conditions Ruled Out
  • Gestational Carrier
  • Minimally Invasive Surgical Procedures Converted to Open
  • 3rd Degree Laceration During Delivery
  • Ectopic Pregnancy
  • Contraceptive Initial Encounter and Surveillance Codes
  • Ovarian Cyst Laterality
  • Supervision of Pregnancy with History of Ectopic or Molar Pregnancy
  • Sarcopenia

 

The first request was for a new code(s) for Castleman Disease, which is a group of related lymphoproliferative disorders with varying clinical features that affects the lymph nodes and related tissues. There is a unicentric and multicentric form of the disease. Options were given to add a new subcategory under D47.Z, Other specified neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, with four new codes broken down by type; and to add one new code under the same category.

There was a request to add new codes for the National Institutes of Health Stroke Scale (NIHSS). The scale has been shown to predict mortality in acute ischemic stroke patients and includes a fifteen item examination that measures a patient’s clinical status in areas including the level of consciousness, facial palsy, best gaze, motor skills, and language. Two options were given – to provide ICD-10-CM codes for each score, or to provide codes for a range of diagnostic scores of the scale.

The American Urological Association (AUA) requested new codes for dyspareunia (painful intercourse), incontinence, and difficulties with micturition. The request for dypareunia is to add four new codes broken down by type of dyspareunia under category N94.1, Dyspareunia, to include: unspecified, superficial, deep, and other. In regards to urinary incontinence, the AUA also requested two new codes under subcategory N39.49, Other specified urinary incontinence, to include: coital incontinence (involuntary loss of urine with coitus) and postural incontinence (involuntary loss of urine associated with change of body position). Finally, three new codes were requested for difficulties with micturition under category R39.149, Other difficulties with micturition, to include: need to immediately re-void, position dependent micturition (having to take specific positions to be able to micturate), and other difficulties with micturition.

From a GI standpoint, there were requests by Forest Laboratories, LLC, made for new codes for irritable bowel syndrome with constipation and chronic idiopathic constipation. Currently, there are ICD-10-CM codes for irritable bowel syndrome (IBS) with and without diarrhea. IBS also has a subtype for IBS with constipation (IBS-C). The request was made to add two new codes under category K58, Irritable bowel syndrome, to include: irritable bowel syndrome with constipation, and other irritable bowel syndrome. In regards to constipation, a new code is requested for chronic idiopathic constipation, also referred to as functional constipation, under category K59.0, Constipation.

The American Congress of Obstetricians and Gynecologists (ACOG) has requested new codes /revisions for the following:

  • Gestational carrier;
  • 3rd degree laceration during delivery under category O70.2;
  • New codes specific to location for ectopic pregnancy under category O00, Ectopic pregnancy, to include abdominal, tubal, ovarian, other, and unspecified;
  • New codes for the initial encounter and surveillance codes for vaginal ring hormonal contraceptive device and transdermal patch hormonal contraceptive device contraceptive methods;
  • Adding new codes to specify laterality for cysts and other disorders under category N83, Noninflammatory disorders of ovary, fallopian tube and broad ligament; and
  • Tabular changes with new codes under category O09, Supervision of high risk pregnancy, separating history of ectopic pregnancy and history of molar pregnancy into two separate subcategories.

Not all requests could be covered in this article. The entire agenda with full meeting materials can be found at: http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials-Items/2014-09-23-MeetingMaterials.html?DLPage=1&DLSort=0&DLSortDir=descending for review.

No final decisions are made at the meetings. Public comment on any of the proposed code revisions from the September meeting are due by November 21.2014. Any comments should be sent to the following e-mail address: .

The next C&M meeting will be held on March 18-19, 2015. Registration for this meeting will be open from February 13, 2015 until March 13, 2015 online at: www.cms.gov/apps/events/default.asp.

About the Author

Betty is the director of ICD-10 development and training. She has more than 25 years of experience in the healthcare field and has worked in a variety of settings with multiple specialties and health plans. She has worked with solo practitioners and large physician groups to assist them with coding, billing, and reimbursement issues. For many years, Betty has spoken at national and regional conferences, been an AAPC workshop presenter, webinar presenter, and ICD-10 Expert Trainer. She has authored multiple articles on coding, billing, and ICD-10.

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