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

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.

References:

https://www.hiacode.com/education/new-icd-10-pcs-procedure-code-changes/