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Part 2: New 2022 ICD-10-PCS Procedure Code Changes

by Sep 8, 2021Industry News, Medical Coding Tips, Patricia Maccariella-Hafey0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

This is Part 2 of a 4 part series on the FY2022 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented.

For FY2022 ICD-10-PCS  there are:

  • 78,220 total codes  (FY2020 total was 78,136)
  • 191 new codes  (556 new last year in FY2021)
  • 107 deleted codes (0 last year in FY2021)
  • 62 revised codes (0 last year in FY2021)

Official Guidelines for Coding and Reporting ICD-10-PCS

There were about 6 updates to the procedure guidelines.

B3.7 for Control vs more definitive root operations  (Bolded text is what changed)

The root operation Control is defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.” Control is the root operation coded when the procedure performed to achieve hemostasis, beyond 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. If a more specific root operation definition applies to the procedure performed, then the more specific root operation is coded instead of Control.

Clarifying that control is only coded when it is BEYOND what would normally be done during a procedure. This will help alleviate errors from coders reporting the control code when it is not necessary.  They also revised the examples used in the guideline.

A second change involved the revision of the tubular body part guideline to clarify it so coders use the guideline not matter what area the tubular body part is.

B4.1c Continuous section of tubular body part

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.  

Example: 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 femoral artery is coded to the external iliac 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.

The remaining official guideline changes were wording and example updates due to expired codes.

 

Major Changes to the ICD-10-PCS Tables

I won’t discuss every change, however, I will review major changes to the codes in the tables.  Note that many body part and substance/technology additions were made to the index as well as the tables.   There were 23 pages in the ICD-10-PCS Fy2022 Index update.

For Central Nervous System, both “Brain” and “Cerebral Hemisphere” were added as body parts under “Extraction.”  This will allow coding of procedures such as microsurgical hemispherotomy performed using cavitron ultrasonic surgical aspiration (CUSA).

For Heart and Great Vessels the qualifier “Orbital Atherectomy Technique” was added so that this technology can be captured. The Diamondback 360 degree coronary orbital atherectomy system is one example. The orbital system allows smoother and more accurate atherectomies to be performed.

A much needed change was adding “Coronary artery, One, Two, Three, Four or more arteries, each as a body part under root operation Fragmentation.  Coronary intravascular lithotripsy (IVL) is a new treatment option for treating calcified lesions in the coronary arteries. Coronary IVL utilizes controlled sound waves in short pulses to selectively crack intimal and medial calcium within the vessel wall without affecting soft tissue. Once fractured, the calcium’s resistance to balloon dilatation is reduced, thereby allowing the blood vessel to be dilated using a low-pressure angioplasty balloon prior to coronary stenting

“Biologic with synthetic substituted, autoregulated, electrohydraulic” was added as a device under  “Replacement, heart.”  This device addition will allow the placement of Carmat total artificial heart (TAH) to be coded. Note that this is not a “Transplant” because the device is synthetic and artificial.

Replacement of Pulmonary Valve now has a new qualifier under zooplastic tissue of “M-Native site>”  This will allow reporting of the Harmony Transcatheter Pulmonary Valve (TPV) System  which is used to treat a leaky native or surgically repaired right ventricular outflow tract (RVOT; It is designed to conform to the native RVOT anatomy.

Left ventricle was added as a body part to root operation “Restriction”

For Upper Arteries body system, both the right and left brachial artery was added under root operation “Bypass” to allow for coding of bypass from the brachial artery (right or left) to a lower arm vein. These will mostly entail arteriovenous fistula creations.

Intracranial artery was added as  a body part to “Fragmentation” in the Upper Arteries Body System.  It was added to identify procedures such as clot maceration performed in a cerebral artery using a microcatheter.

Thankfully, “Bone Marrow” by itself was added a body part under “Extraction” in the Lymphatic and Hemic Systems.  Previously there was no way to capture bone marrow aspiration/extraction to be used for grafts and other purposes unless it was from the sternum, iliac or vertebra.

In the Hepatobiliary and Pancreas body system, the body sites “Liver, Liver right lobe and Liver left lobe” were added to “Division.”  This will allow coding of hepatotomy.

“Infusion device” was added to the “Head and Facial Bones” section so that insertion of an infusion device into the skull can now be coded. This would include intraosseous infusions of the skull.

For “Upper and Lower Bones” we now have a new device, “Spinal Stabilization Device, Vertebral Body Tether” for root operation “Reposition.”   The Tether™ – Vertebral Body Tethering System is a non-fusion spinal device intended to treat idiopathic scoliosis, which is an abnormal curvature in the spine. The Tether™ – Vertebral Body Tethering System is made up of: titanium alloy anchors, bone screws, cord, and set screws. The cord is made of a strong flexible polymer, SULENE® PET (polyethylene-terephthalate).

An anchor and bone screw are placed into the patient’s spine on the side of the spinal curvature. The surgeon will apply tension to the cord to partially straighten the patient’s spine.

For “Upper Joints” we now have qualifiers “Humeral Surface” and “Glenoid Surface” under “Removal” so that removal of these devices can now be coded.

Substance ‘D-Pathogen Reduced Cryoprecipitated Fibrinogen Complex” was added as a substance for administration PRCFC is a highly-processed, pathogen reduced product optimized to provide a concentrated source of fibrinogen to treat fibrinogen deficiency-related bleeding, including massive hemorrhage. INTERCEPT®  blood system is one example.

Also, “percutaneous endoscopic” was added as an approach for irrigation of the peritoneal cavity during laparoscopy for example.  This does NOT apply to dialysate however.

In the Measurement and Monitoring Section, external measurement of “cerebrospinal fluid shunt” levels and now be coded. Direct, continuous measurement of CSF flow represents the most useful indicator of shunt patency for patients with CSF shunts for hydrocephalus. When positioned at the location of a shunt, it provides continuous, noninvasive wireless monitoring of flow of CSF through shunts. “FlowSense” is one brand. The device is adhered to the skin over the localized shunt tubing. The device, which is about the size of an adhesive bandage, must be aligned with the tubing for successful measurement. The device is then paired to a receiver which also displays the measurements.

Added “A-Guidance” as a qualifier for fluoroscopy of the liver when used for guidance during liver procedures.

 

New Technology Section

A new device for “T- Computer-aided Mechanical Aspiration” has been added to New technology section, Cardiovascular system, Extirpation.  Computer Aided Mechanical Aspiration treats occlusions. The Indigo® System uses a mechanical pump (the Penumbra Engine®) to generate a vacuum for aspiration. Additionally, the Lightning™ tubing is the technology aspect of the Indigo® System that detects when the catheter is in patent flow (and therefore removing blood) or in thrombus (and removing clot). This technology automatically stops and starts the Penumbra Engine® to reduce blood loss (e.g., stopping the pump when the catheter is in patent flow, and starting when the physician moves the catheter back into thrombus). The Lightning ™ tubing provides audio and visual signals to the physician when the Indigo® System is in each of these states to help the physician know when to move the catheter for better clot removal.  Usual femoral vein access.

Device “4-Transthoraccic Echocardiography Computer-Aided Guidance” was added to New Technology, Cardiovascular System,  Inspection, to allow coding of the Caption Guidance system.  Caption Guidance is an AI-guided medical imaging acquisition system intended to assist medical professionals in the acquisition of cardiac ultrasound images. It gives real-time guidance to the healthcare practitioners during the acquisition of echocardiography to assist in obtaining anatomically correct images that represent standard 2D echocardiographic diagnostic views and orientations. The Caption Guidance system is software as a medical device (SaMD). To use the software, the Caption Guidance system must be installed on a compatible third-party ultrasound system. It uses a Quality Meter, Prescriptive Guidance, Auto-capture and saves the best clip.

Device “1-Thermal Resistance Energy” was added to New Technology, Cardiovascular System, Bypass of either the right or left radial artery.  The Ellipsys® Vascular Access System with WavelinQ™ is a device that enables percutaneous creation of an AVF using thermal resistance energy. The pAVF created by the Ellipsys® Vascular Access System is between a vein and an artery that remain side-by-side and is distinct from the surgical “end-to-side” approach used for most surgical AVFs. Cubital vein is cannulated, needle placed in vein then it punctures the lumen of adjacent proximal radial artery.  A single Ellipsys® catheter is then inserted so its distal tip is in the artery. Catheter is used to mechanically capture and compress the walls of artery and vein. The power source is activated and thermal resistance energy (i.e., direct heat) is precisely applied to fuse the artery and vein adventitia together and cut an elliptical anastomosis, permanently connecting the artery and vein.

The Thoraflex ™ Hybrid device was addressed in the New Technology section, Cardiovascular System. Two codes are needed to address this, one for Replacement of Thoracic Aorta, Arch and one for Restriction, Thoracic Aorta, Descending.  The Thoraflex™ Hybrid device is a dual-purpose medical device that replaces the ascending aorta and aortic arch while also stabilizing and repairing the descending thoracic aorta in a single procedure, performed by a cardiothoracic surgeon. It is preloaded into a delivery system, which is designed to offer safe delivery and accurate deployment.

New operation “Monitoring” was added to the New Technology section to accommodate Oxygen Saturation monitoring in the upper or lower GI system.  In addition to providing the full-color image, the EP-7000X System allows for the visualization of tissue oxygen saturation (StO2) levels of the GI tract using a 2D endoscopic image during surgeries. The EP-7000X System is comprised of the following components: (1) the video laparoscope EL-R740M; (2) the Processor VP-7000, which relays the image from an endoscope to a video monitor; (3) the Light Source BL-7000X, and (4) the Image Processing Unit EX-0, which has the Oxygen Saturation Endoscopic Imaging (OXEI) feature that receives endoscopic image data.

“Irrigation of Lower GI system with Intraoperative Single-use Oversleeve” was added. The Pure-Vu® System is an oversleeve based, high intensity, intraprocedural cleansing device for colonoscopy procedures. It is designed to connect to currently marketed colonoscopes to avoid aborted and delayed procedures due to poor visualization of the colon mucosa by providing high intensity intra-procedural cleansing of the colon during a colonoscopy.

Also, for “Inspection” of hepatobiliary duct or pancreatic duct, A-Single-use Duodenoscope” was added. Single-use devices  that are disposable could wipe out  cross contamination due to difficult cleaning of reusable duodenoscopes.  Ambu’s aScope Duodeno, a sterile, single-use scope, now approved by FDA.  Boston Scientific EXALT Model D.

For burn injuries, a new device, “F-Bioengineered Allogeneic Construct” was added to New Technology, Skin, Subcutaneous Tissue, Replacement. StrataGraft is an investigational, viable, bioengineered, allogeneic construct consisting of an epidermal layer of viable, fully stratified, allogeneic human Near-diploid Immortalized Keratinocytes (NIKS®) cells growing on a dermal layer, composed of viable normal human dermal fibroblasts embedded in a collagen-rich matrix. It mimics normal skin.

For New Technology,  Bones, Reposition, device  “C-Posterior (Dynamic) Distraction Device” was added. Posterior dynamic stabilization, in which pedicle screw fixation is coupled with a flexible longitudinal connecting system, presumably allows for the normalization of intersegmental motion.  This stands in contrast to traditional fusion surgery, By “restoring” normal motion, mobility is theoretically preserved rather than eliminated.  Distraction = A force applied to a body part to separate bony fragments or joint surfaces.   Coders must be careful to investigate and research various devices to make sure they know the purpose of the device, so that the proper code can be assigned.

For Fusion, “Interbody Fusion Device, Customizable” was added to  allow the coding of devices such as the Aprevo™ Intervertebral Body Fusion Device.  These devices are personalized to incorporate patient-specific features to allow the surgeon to tailor the deformity correction to the individual needs of the patient.   There are four basic steps involved in the creation of a personalized intervertebral body fusion device.

  1. Using the patient’s own computed tomography (CT) scan, create a 3D model of the deformity
  2. Plan surgical correction by using the 3D models
  3. After approval of proposed correction plan by surgeon, implants are designed to specifically match the requirements of the plan
  4. Manufacture personalized implants from 3D printed titanium

 

For Insertion, Anatomical Regions, “Neurostimulator lead” was added to Mouth and Pharynx body part. The Phagenyx® System is designed to treat neurogenic dysphagia. Phagenyx® uses electrical pulses to stimulate sensory nerves in the oropharynx.  It consists of single use catheter and base station.

In Measurement, Physiological Systems, “Intracranial Vascular Activity, Computer-aided Assessment’ and “Pulmonary Artery Flow, Computer-aided Triage and Notification” were added as devices.   The intracranial device uses software that characterizes  the Alberta Stroke Program Early CT Score (ASPECTS) Regions of Interest are measured using CT image data. Continue to report the CT and CT angiogram using the appropriate codes in section B, Imaging along with this new code.  For the pulmonary artery flow, the measurement is used identify software analysis of CTPA to detect PE and notify clinicians promptly.

Four new tests for measuring elements, three  regarding SARS-CoV-2 were added to Physiological Systems, Measurement.  They are “Infection – Mechanical Initial Specimen Diversion of Whole Blood Using Active Negative Pressure” for patients symptomatic for sepsis,  “Intracranial Arterial Flow, Whole Blood mRNA, (ISC-REST),” Infection, Serum/Plasma Nanoparticle Fluorescence SARS-CoV-2 Antibody Detection” and “Measurement Nose, Natural opening, Infection Nasopharyngeal Fluid SARS-CoV-2 Polymerase Chain Reaction.”  Coders must contact there infectious disease departments and determine if these tests are being used and where to find the information in the record, so that proper codes can be applied.

MANY new drugs  and substances were added to the XW0-Introduction tables for FY2022. They include Bromelain-enriched Proteolytic enzyme onto the skin or subcutaneous tissue, Satralizumab-mwge on or into the subcutaneous tissue, and introduction of Narsoplimab Monoclonal Antibody,  Terlipressin, Trilaciclib, Lurbinectedin, Ciltacabtagene Autoleucel, Amivantamab Monoclonal Antibody, Engineered Chimeric Antigen Receptor T-cell Immunotherapy, Autologous AND separate Allogeneic, Axicabtagene Ciloleucel Immunotherapy, Tisagenlecleucel Immunotherapy, Idecabtagene Vicleucel Immunotherapy, Lifileucel Immunotherapy, Brexucabtagene Autoleucel Immunotherapy, Lisocabtagene Maraleucel Immunotherapy,  Antibiotic-eluting Bone Void Filler (for bones) and Nafamostat Anticoagulant administered as a renal replacement therapy via extracorporeal dialysis.   Coders MUST become familiar with the drugs and substances being used at their facilities, the Brand names of them, and also the location of the medical administration records.

Transfusion of High-Dose Intravenous Immune Globulin and Hyperimmune Globulin to treat COVID-19 patients was also added.

In Part 4 of this series, I will provide a detailed table and discussion of many of these drugs that happen to be NTAP drugs, what they are used for, and the new technology payment.  However, some of the additions above did not receive NTAP payment for this year.

Keep an eye out for Part 3 of this 4 part series where the major FY2022 IPPS DRG changes will be discussed.  We also have the full New ICD-10-PCS Codes and Changes FY2022 education module which was approved for 2 CEU credits for AHIMA in Clinical Foundations.

 

References
https://www.cms.gov/medicare/icd-10/2022-icd-10-pcs
https://www.medtronic.com/us-en/healthcare-professionals/products/urology/sacral-neuromodulation-systems/interstim-ii.html
>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094015/
>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329017/

 

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.

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