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.
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.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
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.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.