Take a Peek at 2018 ICD-10-PCS Updates

Prepare for the newest procedure codes for use in hospital inpatient settings.

For fiscal year 2018, ICD-10-PCS guidelines add approaches, qualifiers, body parts, and updates to accommodate 3,652 new codes, 1,821 revised titles, and 646 code deletions. With the total number of PCS codes increasing from 75,789 in 2017 to 78,705 in 2018, awareness of new guidelines is a must for accurate coding and billing.

Coding Guideline Changes

ICD-10-PCS Official Guidelines for Coding and Reporting, sections B3.3, B3.7, and B6.1.a have been revised:
B3.3: Discontinued or incomplete procedures:
If the intended procedure is discontinued or otherwise not completed, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation Inspection of the body part or anatomical region inspected.
Example: A planned aortic valve replacement procedure is discontinued after the initial thoracotomy and before any incision is made in the heart muscle, when the patient becomes hemodynamically unstable. The procedure is coded as an open Inspection of the mediastinum.
The wording “or otherwise not completed” has been added.
B3.7: Root operation control clarified
Guideline B3.7 changes the specified list of definitive root operations to a list of examples. The change to the definition is:
If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing a more definitive root operation, Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.
B6.1.a: Device (general guidelines)
A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. In limited root operations, the classification provides the qualifier values Temporary and Intraoperative, for specific procedures involving clinically significant devices, where the purpose of the device is to be utilized for a brief duration during the procedure or current inpatient stay.
The wording and definition have changed. If the qualifier value is now temporary or intraoperative, and is being used for a “brief” duration, code the device to either value of Temporary or Intraoperative.
A new coding guideline also has been added for 2018.
B4.1.C: Body part (general guidelines)
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.
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 External Iliac Body part.

New Tables

For 2018, 11 new tables are added:
007: Central Nervous System and Cranial Nerves, Dilation
Body Part: 6 = Cerebral Ventricles
Approach: 0 = Open
3 = Percutaneous
4 = Percutaneous Endoscopic
Device: Z = No Device
Qualifier: Z = No Qualifier
01R: Medical Surgical, Peripheral Nervous System, Replacement
Body Parts:
Cervical through Sacral Nerve in Anatomical Order
Approach: 0 = Open
4 = Percutaneous Endoscopic
Device: 7 = Autologous Tissue Substitute
J = Synthetic Substitute
K = Nonautologous Tissue Substitute
Qualifier: Z = No Qualifier
0DD: Medical Surgical, Gastrointestinal System, Extraction
Body Parts:
Esophagus Upper through Anus in Anatomical Order
Approach: 3 = Percutaneous
4 = Percutaneous Endoscopic
8 = Via Natural or Artificial Opening Endoscopic
Device: Z = No Device
Qualifier: X = Diagnostic
0KD: Medical and Surgical, Muscles, Extraction
Body Parts: Head through Foot in Anatomical Order
Approach: 0 = Open
Device: Z = No Device
Qualifier: Z = No Qualifier
0KR: Medical and Surgical, Muscles, Replacement
Body Parts: Head through Foot in Anatomical Order
Approach: 0 = Open
4 = Percutaneous Endoscopic
Device: 7 = Autologous Tissue Substitute
J = Synthetic Substitute
K = Nonautologous Tissue Substitute
Qualifier: Z = No Qualifier
0LD: Medical and Surgical, Tendons, Extraction
Body Parts: Head through Foot in Anatomical Order
Approach: 0 = Open
Device: Z = No Device
Qualifier: Z = No Qualifier
0LH: Medical and Surgical, Tendons, Insertion
Body Parts: Upper Tendon, Lower Tendon
Approach: 0 = Open
3 = Percutaneous
4 = Percutaneous Endoscopic
Device: Y = Other
Qualifier: Z = No Qualifier
0LM: Medical and Surgical, Bursae, and Ligaments
Body Parts: Upper and Lower Bursae
Approach: 0 = Open
3 = Percutaneous
4 = Percutaneous Endoscopic
Device: Y = Other Device
Qualifier: Z = No Qualifier
0QD: Medical and Surgical, Lower Bones, Extraction
Body Parts:
Lumbar Vertebra through Coccyx in Anatomical Order
Approach: 0 = Open
Device: Z = No Device
Qualifier: Z = No Qualifier
0K0: New Technology, Muscles, Tendons, Bursae and Ligaments
Body Parts: Muscle
Approach: 3 = Percutaneous
Substance: 0 = Concentrated Bone Marrow Aspirate
Qualifier: 3 = New Technology Group 3
XY0: New Technology, Extracorporeal, and Introduction
Body Parts: Vein Graft
Approach: X = External
Device: 8 = Endothelial Damage Inhibitor
Qualifier: 3 = New Technology
Major Table Revisions
Within Tables 001-00X, the heading changes to Central Nervous System and Cranial Nerves. Body parts are added (Cerebral Ventricle, Spinal Canal Epidural Space, Subdural Space and Subarachnoid Space. Three device codes are added (Radioactive Element Cesium-131 Collagen Implant, Neurostimulator Lead and Other Device). And the Qualifier X = Diagnostic was remove from all tables within 001-00X for 2018. The effect is seen within the new PCS tables and updates of many device codes and qualifiers throughout the additions/deletions for 2018.
Tables 01H-01W add Device Code Y = Other Device and delete some body parts (Cervical Plexus, Lumbar Plexus, Lumbosacral Plexus and Sacral Plexus). Two device codes are added (J = Synthetic Substitute and K = Nonautologous Tissue Substitute).
Tables 021-02W add an approach (3 = Percutaneous to the Right Atrium), and nine qualifiers are added (Atrium, RT/LT, Axillary Artery to Thoracic Aorta Descending, Brachial Artery to Thoracic Aorta Descending, Pulmonary Trunk Artery RT/LT to Thoracic Aorta Descending, Bi-Ventricular to Heart). We see the addition of a body part (L = Left Ventricle), and an added approach (J = Intraoperative) and (J = Temporary to Intraluminal Device) and device (Y = Other Device). New body parts (P = Pulmonary Trunk and Q= Pulmonary Artery Right, 0-3 Coronary Arteries, Tricuspid Valve, and Mitral Valve).
Within Tables 031-03W, the only change is the addition of a device (Y = Other Device to Upper Artery) and a qualifier (V = Superior Vena Cava Right and Left Brachial Artery).
Tables 041-04W add body systems (Hepatic Artery, Peroneal Artery RT/LT, and Foot Artery RT/LT) and qualifiers (Foot Artery, Lower Extremity Artery, and Lower Extremity Vein). Device codes are deleted from Table 1 (Intraluminal Device, Drug-Eluting are deleted), and two qualifiers (Drug Coated Balloon and Temporary) are added.
Tables 061-04W add two qualifiers (Pulmonary Trunk and Pulmonary Artery RT/LT) and one body part (Hepatic Vein), while deleting another body part (Lesser Saphenous Vein RT/LT).
Within Tables 090-09W, body part K has been revised to describe nasal mucosa and soft tissue rather than nose. An approach is also added (8 = Via Natural or Artificial Opening Endoscopic to the Inner Ear, Middle Ear, and Auditory Ossicles).
Within Tables 0B0-0BW, body parts (Diaphragm RT/LT) are deleted. Indicator Y = Other Device is added to Tracheobronchial Tree, Trachea, Lung RT/LT, Pleura, and Diaphragm.
Tables 0D0-0DW add body part Omentum, and Upper and Lower Intestinal Tract. Greater/Lesser Omentum is deleted. A body part (Upper and Lower Intestinal Tract) is added, as is a device (Y = Other).
Body part (Subcutaneous Tissue and Fascia, Right and Left Neck) is changed within Tables 0J0-0KX. Device codes (Y = Other, W = Vascular Access Device, Totally Implantable, and X = Vascular Access Device, Tunneled) are added.
Within Tables 0S0-0SW, body part descriptions are changed for K = Tarsometatarsal Joint, Right and L = Tarsometatarsal Joint, Left. Three devices are added (2 = Synthetic Substitute Metal on Polyethylene, 4 = Synthetic Substitute Ceramic on Polyethylene, and 6 = Oxidized Zirconium on Polyethylene). One device is deleted (L = Synthetic Substitute Unicondylar).
Tables 0W0-0WW add Qualifier 9 = Manual to Retained Products of Conception.
Several changes are applied to Tables 3E0 for 2018. Within Substance, the Descriptor B now specifies Anesthetic Agent. Within Substance, the Descriptor 7 is deleted and Substance 2 is changed from Antineoplastic to Anti-Infective. An approach (4 = Percutaneous Endoscopic) is added for Coronary Artery, Upper Gastrointestinal, Lower Gastrointestinal, Genitourinary Tract, and Male Reproductive Systems.
Within Table 5A1, the heading is revised to Extracorporeal or Systemic Assistance and Performance. A new duration qualifier
(2 = Continuous) is added to the Respiratory Table.

More to Come

These are just the major revisions. Watch for information on other ICD-10-PCS changes for 2018 in a future issue of Healthcare Business Monthly.

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Amy Pritchett

Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, has been a coder/auditor for over 20 years with her most recent position being held at Change Healthcare as a Manger of the Facility Coding Services Division. She has many years of experience in several different areas of coding and serves as an interim instructor in her hometown of Mobile, Ala. She shares her expertise in publications and as a lecturer at conferences such as Coding-Con for The Coding Institute. She has served as President and Vice President of the Mobile, Ala., local chapter and serves as Secretary for the 2017 year.

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