Coding Tip: Sneak Peek at FY2022 ICD-10-PCS Procedure Additions and Changes
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer. Here is the summary:
FY2022 ICD-10-PCS Guidelines Changes
This link will take you to the guidelines so that you can down load them. https://www.cms.gov/files/document/2022-official-icd-10-pcs-coding-guidelines.pdf
- B3.7 Control vs. more definitive root operations – Once again this guideline has been updated to clarify that Control is assigned when the procedure is done to achieve hemostasisbeyond what would be considered integral to a procedure, utilizes techniques (e.g. cautery, application of substances or pressure, suturing or ligation or clipping of bleeding points at the site) that are not described by a more specific root operation definition, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection. They really just reworded it so it was more clear, and added several newer examples.
- B4.1c Continuous section of tubular body part – This guideline was revised to reflect the true intent and clear up misconceptions. In the past the coder was using the entry point and then going to the furthest point of the tubular body part and assigning that body part in the code. The guideline now reads that the above is not necessarily true, and the coder is to use the body part most proximal or closest to the heart. “If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the furthest anatomical site from the point of entry. anatomically most proximal (closest to the heart) portion of the tubular body part.” “A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the external iliac artery is also coded to the external iliac artery body part”
ICD-10-PCS Character Definitions Updates
- Body parts “Dorsal root ganglion” was added to the cervical, thoracic, lumbar and spinal cord values. Fibular sesamoid and Tibial sesamoid were added to the metatarsal body parts.
- Several new devices were added to existing “Device Value Definitions” such as Carmat total artificial heart (TAH), Alfapump® system, PERCEPT™ PC neurostimulator, InterStim™ II Therapy neurostimulator, InterStim™ Micro Therapy neurostimulator, SynCardia (temporary) total artificial heart (TAH),
- Many new substances were added to existing substance values the Administration section to allow the capture of named drugs and therapies. They include gamma globulin, hyperimmune globulin, immunoglobulin, plyclonal hyperimmune globulin, OTL-101, OTL-103, AVYCAZ® Ceftazidime-avibactam, CRESEMBA® Isavuconazole (Isavuconazonium sulfate), BLINCYTO® Blinatumomab, Idarucizumab, Pradaxa® (dabigatran) , Praxbind® (dabigatran) reversal agent, INTERCEPT fibrinogen complex. Coders must review the tables and new substances to see if they are used in their facility.
- The New Technology Section X has NUMEROUS additions to Substances, many for New Technology 7 payments. Many of the new substances are drugs used to treat COVID and other conditions. They can be viewed in the tables addenda here:https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs
New ICD-10-PCS Code Additions
- Body parts “Brain” and “Cerebral Hemisphere” were added for root operation Extraction to allow for coding of extraction of tissue at these sites.
- Qualifier “7-Orbital Atherectomy” was added to “coronary artery, one, two, three, four or more” body parts under root operation Extirpation to allow removal of clots in these arteries with this device
- “Coronary artery, one, two, three, four or more” and also “Intracranial artery” body parts have been added to root operation Fragmentation to allow for the coding of coronary intravascular lithotripsy (IVL) in treating calcified lesions.
- Device “Biologic with Synthetic Substitute, Autoregulated Electrohydraulic” for heart replacement and “Native Site” to qualifier for pulmonary valve replacement to allow for the placement of Harmony Transcatheter Pulmonary Valve at the native site of the valve.
- “Left ventricle” was added as a body part to root operation Restriction to allow coding of these cardiac procedures.
- The right and left brachial artery was added as a body part to root operation Bypass to allow coding of arteriovenous bypass of brachial artery to lower arm vein.
- Approach values “Via Natural or Artificial Opening” and Via “Natural or Artificial Opening, Endoscopic” were added to Occlusion of lower veins to allow for occlusion of these veins and the hemorrhoidal plexus by these approaches. Also added these two approaches to “Division, Tongue, Palate, Pharynx Muscle.”
- “Bone Marrow” body part was added to root operation Extraction. Previously the coder could only choose the bone marrow of Sternum, Iliac or Vertebral areas. This will allow the coding of extraction of bone marrow at any site.
- Liver, Liver Right Lobe or Left Lobe were added as body parts to Division root operation. Previously only the Pancreas body part was available.
- Added “Infusion Device” device to Insertion, Skull to allow for the infusion device in the skull.
- Added device “Spinal Stabilization Device Vertebral Body Tether” to Reposition of vertebra bones. It is a non-fusion spinal device intended to treat idiopathic scoliosis.
- “Sesamoid bone(s) 1st toe” added as a qualifier for Excision of Metatarsal to identify that specific part.
- Added qualifier “Humeral Surface” and “Glenoid Surface” to Removal of Shoulder Joint Synthetic Substitute.”
- Approach “Percutaneous Endoscopic’ was added to Irrigation of Peritoneal Cavity.
- Added “Cerebrospinal Fluid Shunt” as a Device under Measurement, External, Central Nervous System. The FlowSense is one kind of CSF shunt monitoring system that is adhered to the skin over the shunt tubing. The CSF can then be continually measured.
- “Automated’ was added as a qualifier for Extracorporeal Performance of Continuous Cardiac Output. Such devices are Edwards FloTrac sensor, Nexfin monitor by BMEYE, PWTT, LidCO.
- Liver was added as a body part for Fluoroscopy so that this imaging and guidance can now be coded.
New Technology Section Updates
- The New Technology Section has many new updates, too numerous to review here. They include, for example, adding computer-aided mechanical aspiration of arteries, transthoracic echocardiography computer aided guidance, Bypass of radial artery using Ellipsys® thermal Resistance Energy and new Thoraflex™ hybrid device that replaces the ascending aorta and restricts the thoracic aorta during the same procedure. Two procedures codes a needed, Replacement and Restriction codes.
- There are many new Measurement devices and techniques that have been added to XXE.
- There are many new codes for infusion of various new drugs and substances that may also have a new technology payment for FY2022. We will know which ones are finalized when the FY2022 Final Rule is released. We will have a full document listing these new drugs and substances or devices along with the procedure codes, and payment when we complete our FY2022 ICD-10 and IPPS Education Modules later this summer.
Be sure to look for our series on the New ICD-10 and IPPS Changes coming later this summer!
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Did you get a chance to read the FY2022 IPPS Final Rule? There is an interesting topic that was discussed regarding unspecified ICD-10-CM laterality diagnosis codes, to be exact. In this coding tip we discuss that subject and possible ramifications of it in the coding world.
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.