2017 icd 10 pcs code updatesaapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c... ·...

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2017 ICD 10 PCS Code UpdatesKimberly Cunningham CPC, CIC, CCS

No part of this presentation may be reproduced or transmitted in

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without the expressed written permission of AAPC.

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• Total number of PCS codes in 2016: 71,974

• 3,827 new procedure codes

• 491 revised codes

• 12 deleted codes

• Total number of PCS codes in 2017: 75,789

ICD 10 PCS Code changes for 2017

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ICD 10 PCS Update Highlights

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• In the Medical and Surgical sections, revisions to the definitions of the root operations for Control and Creation procedures

• Addition of Transplantation procedure codes for Face and Hand Transplants

• In the Extracorporeal Therapies section in the Medical and Surgical related procedures, addition of a new root operation Perfusion

• Addition of codes for Assistance, Replacement, Reposition, Fusion, and Introduction have been added to the New Technology Section

• Revision of ICD 10 PCS guidelines

• Coding Updates – Character value additions

• New file available for ICD 10 PCS, Code conversion table

Copyright © 2014 AAPCCopyright/Disclaimer text

2017 ICD 10 PCS UpdatesRoot Operation Updates

• CMS has updated the definition of the Root operation - Control.

• Prior to the 2017 updates, the root operation, Control was only to be used with

postprocedural bleeding. With the update to the definition for the 2017 ICD 10 PCS code

set, control can now be used in situations of “other acute bleeding.”

• The updated definition of the root operation, Control is now defined as “stopping, or

attempting to stop, postprocedural or other acute bleeding.”

Root Operation - Control

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• CMS has updated the definition of the Root operation - Creation.

• Prior to the 2017 updates, the root operation Creation was only to be used for

sex change operations. With the update to the definition for the 2017 ICD 10

PCS code set, creation can now be applied to other body systems.

• The updated definition of the root operation, Creation is “putting in or on

biological or synthetic material to form a new body part that to the extent possible

replicates the anatomic structure or function of an absent body part.”

Root Operation - Creation

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• Extracorporeal Therapies section – Section 6

• Perfusion is extracorporeal treatment by diffusion of therapeutic fluid.

• Perfusion codes are used with donor organs. Fluid is pumped through the organ

to preserve it.

• Example:

• 6AB50BZ – Perfusion of Circulatory Donor Organ, Single

New Root Operation - Perfusion

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Copyright/Disclaimer text

2017 ICD 10 PCS UpdatesGuideline Updates

Changes to the Official ICD 10 PCS Coding Guidelines

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Specific changes occurred to the following Guidelines:

• Changes that were made to the ICD 10 PCS guidelines are in response to public comment

and Cooperative Parties review.

• B2.1a

• B3.2

• B3.4a

• B3.6b

• B3.7

• B3.9

• B4.2

• B4.4

B2.1a – General Guidelines

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2016 Guideline

B2.1a

The procedure codes in the general anatomical regions body systems should only be used

when the procedure is performed on an anatomical region rather than a specific body part

(e.g., root operations Control and Detachment, Drainage of a body cavity) or on the rare

occasion when no information is available to support assignment of a code to a specific

body part.

Example: Control of postoperative hemorrhage is coded to the root operation Control

found in the general anatomical regions body systems.


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What’s new for 2017???

• The guideline was changed to read that the “anatomical regions body systems” can be

used when the procedure is performed on an anatomical region rather than a specific body

part.

• Examples of a Chest tube drainage of the pleural cavity coded to the root operation

Drainage found in the general anatomical regions body systems.

• Reference Drainage, then Pleural Cavity to locate the first four characters

of the PCS code.

• Also an example of suture repair of the abdominal wall is coded to the root operation

Repair in the general anatomical regions body system. Reference Repair, then abdominal

wall.


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2017 Guideline

B2.1a

The procedure codes in the general anatomical regions body systems can be used when

the procedure is performed on an anatomical region rather than a specific body part (e.g.,

root operations Control and Detachment, Drainage of a body cavity) or on the rare

occasion when no information is available to support assignment of a code to a specific

body part.

Examples: Control of postoperative hemorrhage is coded to the root operation Control

found in the general anatomical regions body systems.

Chest tube drainage of the pleural cavity is coded to the root operation Drainage found in

the general anatomical regions body systems. Suture repair of the abdominal wall is

coded to the root operation Repair in the general anatomical regions body system.

B3.2 – Multiple Procedures

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2016 Guideline

During the same operative episode, multiple procedures are coded if:

a. The same root operation is performed on different body parts as defined by distinct values of

the body part character.

Example: Diagnostic excision of liver and pancreas are coded separately.

b. The same root operation is repeated in multiple body parts, and those body parts are

separate and distinct body parts classified to a single ICD-10-PCS body part value.

Example: Excision of the sartorius muscle and excision of the gracilis muscle are

both included in the upper leg muscle body part value, and multiple procedures are

coded.

c. Multiple root operations with distinct objectives are performed on the same body part.

Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately.

d. The intended root operation is attempted using one approach, but is converted to a different

approach.

Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is

coded as percutaneous endoscopic Inspection and open Resection.


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• An additional example is added for root operations performed on different body parts with distinct character values during the same operative episode. The new example provided is that of a resection of a lesion of the ascending colon and an excision of a lesion of the transverse colon. A code for each excision procedure can be coded because the body parts are represented with distinct character values. The ascending colon is represented by body part character “K” under the root operation Excision, and the transverse colon is represented by body part character “L.”

• An additional example is provided to guidance on the proper coding of multiple procedures repeated on multiple body parts during the same operative episode. The example of Extraction of multiple toenails is represented with a separate code for each toenail removed.


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2017 Guideline

During the same operative episode, multiple procedures are coded if:

a. The same root operation is performed on different body parts as defined by distinct values of the body

part character.

Examples: Diagnostic excision of liver and pancreas are coded separately.

Excision of lesion in the ascending colon and excision of lesion in the transverse colon

are coded separately.

b. The same root operation is repeated in multiple body parts, and those body parts are separate and

distinct body parts classified to a single ICD-10-PCS body part value.

Examples: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the

upper leg muscle body part value, and multiple procedures are coded. Extraction of multiple toenails are

coded separately.

c. Multiple root operations with distinct objectives are performed on the same body part.

Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately.

d. The intended root operation is attempted using one approach, but is converted to a

different approach.

Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is

coded as percutaneous endoscopic Inspection and open Resection.

B3.4a – Biopsy procedures

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2016 Guideline

Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic.

Examples:

Fine needle aspiration biopsy of lung is coded to the root operation Drainage with the qualifier Diagnostic.

Biopsy of bone marrow is coded to the root operation Extraction with the qualifier Diagnostic.

Lymph node sampling for biopsy is coded to the root operation Excision with the qualifier Diagnostic.


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More specificity is provided for the biopsy in order to properly describe the

procedure code for the first example of a fine needle aspiration of fluid in the lung.

In the 2016 guidelines, the example stated that there was a fine needle aspiration of

the lung, which would correctly code to the root operation Excision, not Drainage,

however, both procedures would be reported with the 7th character qualifier

Diagnostic to identify that it is a biopsy procedure.


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2017 Guideline

Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic.

Examples: Fine needle aspiration biopsy of fluid in the lung is coded to the root operation

Drainage with the qualifier Diagnostic.

Biopsy of bone marrow is coded to the root operation Extraction with the qualifier

Diagnostic.

Lymph node sampling for biopsy is coded to the root operation Excision with the

qualifier Diagnostic.

B3.6b – Bypass Procedures

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2016 Guideline

Coronary arteries are classified by number of distinct sites treated, rather than

number of coronary arteries or anatomic name of a coronary artery (e.g., left anterior

descending). Coronary artery bypass procedures are coded differently than other

bypass procedures as described in the previous guideline. Rather than identifying

the body part bypassed from, the body part identifies the number of coronary artery

sites bypassed to, and the qualifier specifies the vessel bypassed from.

Example: Aortocoronary artery bypass of one site on the left anterior descending

coronary artery and one site on the obtuse marginal coronary artery is classified in

the body part axis of classification as two coronary artery sites and the qualifier

specifies the aorta as the body part bypassed from.

B3.6b – Bypass procedures

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The first sentence of the guideline was removed.

“Coronary artery bypass procedures are coded differently than other bypass

procedures as described in the previous guideline.”

B3.6b – Bypass procedures

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2017 Guideline

Coronary artery bypass procedures are coded differently than other bypass

procedures as described in the previous guideline. Rather than identifying the body

part bypassed from, the body part identifies the number of coronary arteries

bypassed to, and the qualifier specifies the vessel bypassed from.

Example: Aortocoronary artery bypass of the left anterior descending coronary

artery and the obtuse marginal coronary artery is classified in the body part axis of

classification as two coronary arteries, and the qualifier specifies the aorta as the

body part bypassed from

B3.6c – Bypass procedures

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2016 Guideline

If multiple coronary artery sites are bypassed, a separate procedure is coded for

each coronary artery site that uses a different device and/or qualifier.

Example: Aortocoronary artery bypass and internal mammary coronary artery

bypass are coded separately.


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In the first sentence artery sites was changed to arteries.

In the example provided, an aortocoronary bypass procedure is done during the same operative episode as an internal mammary coronary artery bypass procedure. Let’s assume this is an open procedure. The correct coding for these procedures is:

02100AW – Bypass Coronary Artery, One Site, from Aorta with Autologous Arterial Tissue, Open Approach

02100Z9 – Bypass Coronary Artery, One Site, from Left Internal Mammary Artery, Open Approach


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2017 Guideline

If multiple coronary arteries are bypassed, a separate procedure is coded for each

coronary artery that uses a different device and/or qualifier.

Example: Aortocoronary artery bypass and internal mammary coronary artery

bypass are coded separately.

B3.7 – Control vs. more definitive root operations

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2016 Guideline

The root operation Control is defined as, “Stopping, or attempting to stop,

postprocedural bleeding.” If an attempt to stop postprocedural bleeding is initially

unsuccessful, and to stop the bleeding requires performing any of the definitive root

operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or

Resection, then that root operation is coded instead of Control.

Example: Resection of spleen to stop postprocedural bleeding is coded to Resection

instead of Control.


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The guideline change now allows for the root operation of Control to be used for

instances of postprocedural bleeding, as well as other acute bleeding.


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2017 Guideline

The root operation Control is defined as, “Stopping, or attempting to stop,

postprocedural or other acute bleeding.” If an attempt to stop postprocedural or

other acute bleeding is initially unsuccessful, and to stop the bleeding requires

performing any of the definitive root operations Bypass, Detachment, Excision,

Extraction, Reposition, Replacement, or Resection, then that root operation is coded

instead of Control.

Example: Resection of spleen to stop postprocedural bleeding is coded to Resection

instead of Control

B3.9 – Excision for graft

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2016 Guideline

If an autograft is obtained from a different body part in order to complete the

objective of the procedure, a separate procedure is coded.

Example: Coronary bypass with excision of saphenous vein graft, excision of

saphenous vein is coded separately.


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The guideline now indicates that an autograft obtained from a different procedural

site can be codes as a separate procedure. “Different procedure site” replaces the

terms “body part.”


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2017 Guideline

If an autograft is obtained from a different procedure site in order to complete the

objective of the procedure, a separate procedure is coded.

Example: Coronary bypass with excision of saphenous vein graft, excision of

saphenous vein is coded separately

B4.2 – Branches of body parts

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2016 Guideline

Where a specific branch of a body part does not have its own body part value in

PCS, the body part is coded to the closest proximal branch that has a specific body

part value.

Example: A procedure performed on the mandibular branch of the trigeminal nerve

is coded to the trigeminal nerve body part value.


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Further specificity has been added to this guideline with specific reference to the

cardiovascular system and the correct body part value. An additional example is

provided to the guideline illustrating the application of the specificity that was added.

In the example, there is Occlusion of the bronchial artery. This is coded to the body

part value, Upper Artery, with the body system value Upper Arteries, and not to

Thoracic Aorta, Descending in the Heart and Great Vessels.


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2017 Guideline

Where a specific branch of a body part does not have its own body part value in

PCS, the body part is typically coded to the closest proximal branch that has a

specific body part value. In the cardiovascular body systems, if a general body part

is available in the correct root operation table, and coding to a proximal branch

would require assigning a code in a different body system, the procedure is coded

using the general body part value.

Examples: A procedure performed on the mandibular branch of the trigeminal nerve

is coded to the trigeminal nerve body part value.

Occlusion of the bronchial artery is coded to the body part value Upper Artery in the

body system Upper Arteries, and not to the body part value Thoracic Aorta,

Descending in the body system Heart and Great Vessels.

B4.4 – Coronary arteries

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2016 Guideline

The coronary arteries are classified as a single body part that is further specified by

number of sites treated and not by name or number of arteries. Separate body part

values are used to specify the number of sites treated when the same procedure is

performed on multiple sites in the coronary arteries.

Examples: Angioplasty of two distinct sites in the left anterior descending coronary

artery with placement of two stents is coded as Dilation of Coronary Arteries, Two

Sites, with Intraluminal Device.

Angioplasty of two distinct sites in the left anterior descending coronary artery, one

with stent placed and one without, is coded separately as Dilation of Coronary

Artery, One Site with Intraluminal Device, and Dilation of Coronary Artery, One Site

with no device.


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The guideline for coronary arteries has been updated to allow for more specificity

with the coding of coronary artery procedures. With the 2016 guidelines, and code

set, there was not a qualifier value for the number of stents the patient had placed.

For 2017, the code set provides values for multiple stent placement, up to 4 or more

devices.


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2017 Guideline

The coronary arteries are classified as a single body part that is further specified by

number of arteries treated. One procedure code specifying multiple arteries is used

when the same procedure is performed, including the same device and qualifier

values.

Examples: Angioplasty of two distinct coronary arteries with placement of two stents

is coded as Dilation of Coronary Artery, Two Arteries with Two Intraluminal Devices.

Angioplasty of two distinct coronary arteries, one with stent placed and one without,

is coded separately as Dilation of Coronary Artery, One Artery with Intraluminal

Device, and Dilation of Coronary Artery, One Artery with no device.

Copyright © 2014 AAPCCopyright/Disclaimer text

2017 ICD 10 PCS UpdatesCode Updates

So how do I learn 3,827 new procedure codes???

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• Most of the new ICD 10 PCS codes can be found in the Medical Surgical section, with the

majority being added to the Heart and Great Vessels Body Systems.

• Other body systems from the Medical Surgical Section where updates occur are the Upper

and Lower Arteries, Upper Veins, Lower Joints, and Anatomical Regions – general and

upper extremities.

• Additional character values have been added for each body system.

• Additions were also made to the Medical and Surgical related sections in the

Administration Section, Extracorporeal Therapies and New Technology.

Code Updates

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Heart and Great Vessels

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Root Operation - Bypass

• Body Part Character Additions

• P Pulmonary Trunk

• Q Pulmonary Artery, Left

• R Pulmonary Artery, Right

• W Thoracic Aorta, Descending

• X Thoracic Aorta, Ascending Arch

• Device Character Addition

• 8 Zooplastic Tissue – Animal (non human) tissue

• Qualifier Character Additions

• A Innominate Artery

• B Subclavian

• D Carotid


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Root Operation - Destruction





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Root Operation - Dilation





• 5 Intraluminal Device, Drug Eluting, Two

• 6 Intraluminal Device, Drug Eluting, Three

• 7 Intraluminal Device, Drug Eluting, Four of More

• E Intraluminal Device, Two

• F Intraluminal Device, Three

• G Intraluminal Device, Four or More


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Root Operation - Excision



• X Thoracic Aorta, Ascending/Arch


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Root Operation - Extirpation





46

Root Operation - Insertion





47

Root Operation - Occlusion


• H Pulmonary Valve


48

Root Operation - Release





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Root Operation - Removal

• Device Character Additions

• N Intracardiac Pacemaker


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Root Operation - Repair




• F Aortic Valve

• G Mitral Valve

• J Tricuspid Valve

• Approach Character Addition

• 0 Open

• 3 Percutaneous

• 4 Percutaneous Endoscopic


• J Truncal Valve

• E Atrioventricular valve, left

• G Atrioventricular valve, right


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Root Operation - Replacement





52

Root Operation - Reposition


• 0 Coronary Artery, One

• 1 Coronary Artery, Two Arteries




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Root Operation - Supplement




• F Aortic Valve

• G Mitral Valve

• J Tricuspid Valve


• 0 Open

• 3 Percutaneous



• 7 Autologous Tissue Substitute

• 8 Zooplastic Tissue

• J Synthetic Substitute

• K Nonautologous Tissue Substitute


• J Truncal Valve

• E Atrioventricular valve, left

• G Atrioventricular valve, right


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Root Operation - Restriction





• E Intraluminal Device, Branched or Fenestrated, One or Two Arteries

• F Intraluminal Device, Branched or Fenestrated, Three or more Arteries


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Root Operation - Revision


• N Intracardiac Pacemaker

Upper Arteries

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Upper Arteries

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• Qualifier Character Addition

• 6 Bifurcation

Lower Arteries

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• 6 Bifurcation

Lower Arteries

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• 6 Bifurcation

Upper Veins

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Root Operation - Insertion


• 2 Monitoring Device

• M Neurostimulator Lead

Upper Veins

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• Body Part Character Addition

• 0 Azygos Vein

• 3 Innominate Vein, right

• 4 Innominate Vein, left


• 0 Open

• 3 Percutaneous


• X External




Upper Veins

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• 0 Azygos Vein

• 3 Innominate Vein, right

• 4 Innominate Vein, left


• 0 Open

• 3 Percutaneous


• X External




Lower Joints

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• A Hip Joint, Acetabular Surface, Right

• E Hip Joint, Acetabular Surface, Left

• R Hip Joint, Femoral Surface, Right

• S Hip Joint, Femoral Surface, Left

• T Knee Joint, Femoral Surface, Right

• U Knee Joint, Femoral Surface, Left

• V Knee Joint, Tibial Surface, Right

• W Knee Joint, Tibial Surface, Left

• C Knee Joint, Right

• D Knee Joint, Left


• 0 Open

• 3 Percutaneous





• C Patellar Surface

Lower Joints

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• L Synthetic Substitute, Unicondylar

Lower Joints

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• A Hip Joint, Acetabular Surface, Right

• E Hip Joint, Acetabular Surface, Left

• R Hip Joint, Femoral Surface, Right

• S Hip Joint, Femoral Surface, Left

• T Knee Joint, Femoral Surface, Right

• U Knee Joint, Femoral Surface, Left

• V Knee Joint, Tibial Surface, Right

• W Knee Joint, Tibial Surface, Left

• C Knee Joint, Right

• D Knee Joint, Left


• 0 Open

• 3 Percutaneous


• X External




• C Patellar Surface

Anatomical Regions, General

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Root Operation - Transplantation

• Addition of new codes for a Face Transplantation Procedure

• Transplantation is defined as putting in or on all or a portion of a living body part taken from another

individual or animal to physically take the pace and/or function of all or a portion of a similar body part.

• 0WY20Z0 – Face transplantation, Allogenic Donor, Open Approach

• Allogenic Donor – from another person – genetically different - siblings

• 0WY20Z1 – Face transplantation, Syngeneic Donor, Open Approach

• Syngeneic Donor – from another person – genetically identical - Twins

Anatomical Regions, Upper Extremities

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Root Operation - Transplantation

• Addition of new codes for a Hand Transplantation Procedure

• Transplantation is defined as putting in or on all or a portion of a living body part taken from another

individual or animal to physically take the pace and/or function of all or a portion of a similar body part.

• 0XYJ0Z0 – Hand transplantation, Allogenic Donor, Right Hand, Open Approach

• 0XYK0Z1 – Hand transplantation, Syngeneic Donor, Left Hand, Open Approach

Administration Section – Physiological Systems

and Anatomical Regions

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Root Operation - Introduction


• 0 Open

New Technology – Cardiovascular System

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Root Operation - Assistance

• Assistance is taking over a portion of a physiological function by extracorporeal means

• X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2

Section(X) New Technology

Body System(2) Cardiovascular System

Operation(A) Assistance

Body Part(5) Innominate Artery and Left Common Carotid Artery

Approach(3) Percutaneous

Device /Substance /Technology(1) Cerebral Embolic Filtration, Dual Filter

Qualifier(2) New Technology Group 2

New Technology – Cardiovascular System

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Section X New Technology

Body System 2 Cardiovascular

System

Operation R Replacement

Body Part Approach Device/Substance/

Technology

Qualifier

F Aortic Valve 0 Open

3 Percutaneous

4 Percutaneous

Endoscopic

3 Zooplastic Tissue,

Rapid Deployment

Technique

2 New Technology

Group 2

New Technology – Skin, Subcutaneous Tissue,

Fascia and Breast

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Body System H Skin, Subcutaneous

Tissue, Fascia and

Breast

Operation R Replacement


Technology

Qualifier

P Skin X External L Skin Substitute,

Porcine Liver Derived

2 New Technology

Group 2

New Technology – Bones

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Root Operation - Reposition


Body System N Bones

Operation S Reposition


Technology

Qualifier

0 Lumbar Vertebra

3 Cervical Vertebra

4 Thoracic Vertebra

0 Open

4 Percutaneous

Endoscopic

3 Magnetically

Controlled Growth Rod

2 New Technology

Group 2

New Technology – Joints

73

Root Operation - Fusion


Body System R Joints

Operation G Fusion


Technology

Qualifier

0 Occipital-cervical Joint

1 Cervical Vertebral Joint

2 Cervical Vertebral Joints, 2 or more

4 Cervicothoracic Vertebral Joint

6 Thoracic Vertebral Joint

7 Thoracic Vertebral Joints, 2 to 7

8 Thoracic Vertebral Joints, 8 or more

A Thoracolumbar Vertebral Joint

B Lumbar Vertebral Joint

C Lumbar Vertebral Joints, 2 or more

D Lumbosacral Joint

0 Open 9 Interbody Fusion

Device, Nanotextrured

Surface

2 New Technology

Group 2

New Technology – Anatomical Regions

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Root Operation - Introduction


Body System W Anatomical Regions

Operation 0 Introduction


Technology

Qualifier

3 Peripheral Vein 3 Percutaneous 7 Andexanet Alfa, Factor Xa

Inhibitor Reversal Agent

9 Defibrotide Sodium

Anticoagulant

2 New Technology Group 2

4 Central Vein 3 Percutaneous 7 Andexanet Alfa, Factor Xa

Inhibitor Reversal Agent

9 Defibrotide Sodium

Anticoagulant

2 New Technology Group 2

D Mouth and Pharynx X External 8 Uridine Triacetate 2 New Technology Group 2

Questions?

75

• Centers for Medicare and Medicaid Services

• FY 2017 IPPS Final Rule Homepage

• https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html

76

References:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html

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