Part 2: New ICD-10 Codes and IPPS Changes
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
New ICD-10-CM Codes
In Part 1 of this 4 part series we discussed some of the new ICD-10-CM diagnosis changes. In Part 2 we present the significant ICD-10-PCS procedure code changes. Here is the breakdown:
72,184 total ICD-10-CM codes for FY2020
- 324 changes all together (2019 had 473 changes)
- 273 new codes (2019 had 279 new codes)
- 21 deleted codes (2019 had 51 deleted codes)
- 30 revised codes (2019 had 143 revised codes)
Official Guidelines for Coding and Reporting ICD-10-PCS
There are several minor changes to the guidelines that include adding more descriptive terms, and adding examples. An exception was added to B3.1b Multiple Procedures in that mastectomy followed by breast reconstruction, both resection and replacement of the breast are coded separately. Likewise, in guideline B3.9 for Excision of Graft, clarification of DIEP was added: Replacement of breast with autologous deep inferior epigastric artery perforator (DIEP) flap, excision of the DIEP flap is not coded separately. The seventh character qualifier value Deep Inferior Epigastric Artery Perforator Flap in the Replacement table fully specifies the site of the autograft harvest.
A brand new Section D – Radiation Therapy has been added. This will help coders to know when to report an “Insertion” code with device value “radioactive element” in addition the modality in the radiation therapy section, and when not to. For example, brachytherapy with implantation of a low dose rate brachytherapy source left in the body at the end of the procedure is coded to the applicable treatment site in section D, Radiation Therapy, with the modality Brachytherapy, the modality qualifier value Low Dose Rate, and the applicable isotope value and qualifier value. The implantation of the brachytherapy source is coded separately to the device value “radioactive element” in the appropriate Insertion table of the Medical and Surgical section (0). The Radiation Therapy section code identifies the specific modality and isotope of the brachytherapy, and the root operation Insertion code identifies the implantation of the brachytherapy source that remains in the body at the end of the procedure. There is an exception to this for Cesdium-131 Collagen implant in that this procedure identifies both the implantation and brachytherapy, so only one code is needed. There is also guidance on placing temporary applicators for delivering brachytherapy.
Guidelines for Section E – New Technology Section (X codes) was updated to state that Section X codes fully represent the specific procedure described in the code title, and do not require additional codes from other sections of ICD-10-PCS. So all the coder needs to assign is the new technology code.
Major Changes to the ICD-10-PCS Tables
Coders will notice than there were many deleted ICD-10-PCS codes for FY2020. This is primarily because of the removal of “Bifurcation” as a qualifier in all upper and lower artery tables. However it remains as a choice for the coronary arteries. That change eliminated quite a few codes. This was a troublesome area for coders as many did not know when to assign the bifurcation qualifier.
ICD-10-PCS also removed approach “external” from all breast procedures. The index has been updated to indicate that procedures performed on the skin of the breast be coded to body part “Skin, chest” and not to breast.
In the Administration Section, body part value for peripheral or central “artery” was removed, eliminating many ICD-10-PCS codes. This was done because transfusions are done through veins, not arteries.
A device value for Internal fixation device, intramedullary limb lengthening for insertion of upper or lower bones was added. This includes the PRECICE intramedullary limb lengthening system. This would be coded to root operation “Insertion” and not “Reposition” as the surgeon is lengthening the bone, not repositioning a fracture.
A new device for Intraluminal Device, Flow Diverter for Restriction in Upper Arteries was added for the Pipeline™ and Surpass Streamline ™ Flow Diverter devices. The flow diverter, sometimes called a stent is designed to reliably open and provide consistent mesh density across the neck of the aneurysm to aid in aneurysm occlusion while maintaining perforator artery patency. Coders will need to be sure to research these types of devices that the proper device value is assigned.
A new device value for Subcutaneous Defibrillator Lead in Subcutaneous Tissue and Fascia for the S-ICD ™ lead was added. The EMBLEM S-ICD System is an innovative and truly novel ICD. Unlike traditional ICDs that require placement of at least one lead in or on the heart, the S-ICD System is implanted just under the skin and provides the patient protection from sudden cardiac arrest without invading the heart and blood vessels. It is the only fully subcutaneous (under the skin) ICD available at the current time. However coders should be on the look out for new S-ICDs.
Innominate artery, also known as the brachiocephalic artery was added as a qualifier under the Bypass root operation in the Heart and Great Vessels body system In addition, coronary arteries were added to the “Insertion” and “Supplement” root operations. Coders must be careful not to use “Insertion” and the coronary artery body part for PCI stent insertion. PCI angioplasties are still coded to root operation Dilation. The root operation for “Insertion” of device in coronary artery is for s stent insertions DURING TAVR OR VALVE REPLACEMENTS to help prevent the risk of coronary obstruction following valve insertion. So this type of stent is not really treating a condition such as CAD, it is a preventative device at time of other surgery. Supplement of coronary arteries is done to reinforce or augment coronary arteries, such as a stent graft placed to seal and reinforce a perforated/dissection of artery status post atherectomy. The objective is to supplement the wall of the artery.
Coders can not code EGD with occlusion of gastric vein as “Gastric Vein” was added as body part value for procedures done via natural or artificial opening and natural or artificial opening endoscopic.
Under Performance, Circulatory a new Duration of “Intraoperative” was added so coders could code ECMO done intraoperatively. In recent years, providers are increasingly performing short-term, percutaneous ECMO procedures in addition to open-chest ECMO. ECMO was originally only used for respiratory support, but today, ECMO is commonly used for respiratory and cardiac support. CentralECMO cannulation involves sternotomy and direct surgical cannulation of the right atrium and aorta. This involves two open insertions; arterial and venous and provides cardiorespiratory support.
V A Peripheral ECMO cannulation involves two femoral percutaneous insertions; arterial and venous. This type of ECMO support provides respiratory and circulatory support.
V V ECMO requires two venous insertions, one in the upper veins and one in the lower veins. This provides respiratory support only.
For “Other Procedures,” a new method of “Fluorescence Guided Procedure” was added. An example is a fluorescent label attached to a marker (e.g. a monoclonal antibody) that binds specifically and selectively to tumor cells, helping the surgeon ‘see’ the tumor and metastatic tissue in real time. Fluorescent markers can be used with a wide range of procedures, including classic (‘open’) surgery, laparoscopic surgery, and diagnostic procedures such as colonoscopy.
A new device for dilation of artery with sustained release drug-eluting intraluminal device was added as a New Technology X code, X27. The Eluvia and SAVAL stents are two such devices.
Another new device called a cerebral embolic filtration, single deflection filter was added to new technology table X2A. One example is the Embrella Embolic Deflector (Embrella Cardiovascular Inc, Wayne, Pa) which was designed to meet the need for embolic protection during procedures on the heart or involving the passage of catheters over the aortic arch. Emboli may arise from manipulation of the heart valves or atria and aorta and this device deflects them. There are several types of aortic arch filters that the coder must become familiar with. They include: a single filter but not a deflection filter (Embol-X)
Two single deflection filters called Embrella, TriGuard to the right. (Device 2 – Cerebral Embolic Filtration, Single Deflection Filter) and a third one called Sentinel which is a dual filter (Device 1 – Cerebral Embolic Filtration, Dual Filter)
In Part 3, the pertinent IPPS changes will be presented. In the final Part 4, New Technologies (X codes) and payment impacts will be presented and discussed in detail.
The information contained in this coding advice 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.
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. Here are the top three ICD-10-CM chapters where HIA identified coding opportunities: Z00-Z99 – Factors influencing health status and contact with health services; I00-I99 – Circulatory system and; R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
This is Part 5 of a five part series on the new 2020 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 2020 CPT codes. In this series we will explore the CPT changes for FY 2020 and include examples to help the coder understand the new codes. There is 3 new digestive system codes with 1 deletion and 2 revised; 1 revised urinary system codes with new category III codes; 6 new with 20 deleted nervous system codes with 3 revisions; 2 new eye codes with 3 revisions; and finally a new category III auditory code.
This is Part 3 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
This is Part 2 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include some examples to help the coder understand the new codes. There are 11 new musculoskeletal CPT codes added with 1 deletion and 0 revisions.
This is Part 1 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include examples to help the coder understand the new codes. For 2020 in general, there were 248 new CPT codes added, 71 deleted and 75 revised.
This is Part 6 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 6 focuses on revision of a reconstructed breast.
This is Part 5 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 5 focuses on the coding of different types of autologous tissue breast reconstruction procedures.
Part 4: CPT Breast Education Series | Use of Acellular Dermal Matrix with Breast Implant Reconstruction
This is Part 4 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 4 focuses on the use of acellular dermal matrix with breast implant reconstruction.
Part 3: CPT Breast Education Series | Immediate Versus Delayed Permanent Breast Implant Reconstruction
This is Part 3 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 3 focuses on the difference between immediate and delayed permanent breast implant reconstruction.
This is Part 2 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 2 focuses on the use of tissue expanders in breast reconstruction.
With the implementation of ICD-10-PCS the description of codes became much more detailed to describe exactly what is being performed. Cardiac catheterization is one of the descriptions that changed to further detail exactly what is being performed during the procedure.
This is Part 1 of a 6-part series focusing on CPT coding of reconstructive procedures following mastectomy. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 1 is an overview of the types of breast reconstruction techniques commonly used. Future topics in this series will go into more detail of each technique and the CPT coding implications.
With Christmas fast-approaching, we’re making a list of our favorite holiday movies and checking it twice. And in the spirit of good humor and cheer, we’ve added some ICD-10 codes to these holiday classics. Have a safe, happy, and healthy holiday everyone!
“Lobar” pneumonia references a form of pneumonia that affects a specific lobe or lobes of the lung. This is a bacterial pneumonia and is most commonly community acquired. Antibiotics are almost always necessary to clear this type of pneumonia.
Why are so many sepsis records denied? It’s hard to say why there seem to be so many sepsis denials of late, but most likely this is due to the multiple sets of criteria for the diagnosis of sepsis, change in definition of sepsis, as well as physician documentation.
In Parts 1, 2 and 3 we learned about what sepsis is, sequencing of sepsis and what documentation is needed to report severe sepsis. In Part 4, we will look at clinical indicators needed to clinically support the diagnosis of sepsis and determine if a query is indicated.
Severe sepsis occurs when sepsis progresses and signs of organ dysfunction/failure develop. One site stated that approximately 30% of patients with severe sepsis do not survive. Patients may develop one organ dysfunction/failure, multi-system organ failure and/or septic shock.
In Part 2 of our Sepsis Series, we are going to focus on sequencing of sepsis when the diagnosis is clearly documented. Later in the series we will look at what to do when the diagnosis is not clearly documented.
In this series, we will learn what sepsis is or causes of sepsis, how to sequence the diagnosis in ICD-10-CM, what are the clinical indicators for sepsis, is a query necessary before reporting the diagnosis of sepsis, and how to prevent denials on sepsis records.
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 FY2020 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2020.
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 FY2020. On August 2, 2019, CMS published the Final Rule for IPPS (CMS-1716) FY2020 IPPS Final Rule.
This is Part 1 of a 4 part series on the FY2020 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. There are 72,184 total ICD-10-CM codes for FY2020.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.