New 2022 ICD-10-PCS Procedure Code Changes: Part 1

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.

Reference:

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