Learn and Apply the 2020 ICD-10-PCS Code Updates

Learn and Apply the 2020 ICD-10-PCS Code Updates

To help you ease into new coding, consume the changes
in the sections that will impact your daily claims processing.

Even with a decrease in the amount of ICD-10-PCS codes for fiscal year 2020, it can seem a bit daunting to take in 734 new codes, two revised codes, and 2,056 deleted codes. Now is the perfect time to see how the updates will affect your code choices, beginning Oct. 1, 2019.

As we’ve seen previously, most of the changes are in the Medical and Surgical section of the code book because it’s the biggest section; although, new technology also has a lot of activity this year, as well (considering its size).

Take Note of Procedural Code Changes

Table 001 Bypass of the central nervous system and cranial nerves has a new qualifier added. Qualifier A Subgaleal Space has been added to identify another destination option for a cerebral ventricle bypass.

Table 021 Bypass heart and great vessels has four additional body part options added:

W – Thoracic Aorta, Descending, Open, with device options

W – Thoracic Aorta, Descending, Open, with no device options

W – Thoracic Aorta, Descending, Percutaneous Endoscopic, with device options

X – Thoracic Aorta, Ascending/Arch, Open or Percutaneous Endoscopic, with device options

Table 02H Insertion heart and great vessels has additional body part options added:

0 – Coronary Artery, One Artery

1 – Coronary Artery, Two Arteries

2 – Coronary Artery, Three Arteries

3 – Coronary Artery, Four or More Arteries

Table 02U Supplement heart and great vessels also has four additional body part options added:

0 – Coronary Artery, One Artery

1 – Coronary Artery, Two Arteries

2 – Coronary Artery, Three Arteries

3 – Coronary Artery, Four or More Arteries

Table 031 Bypass upper arteries has an additional qualifier added as another option for bypass destination — W Lower Extremity Vein — as well as the additional approach 3 Percutaneous for the ulnar artery and radial artery.

Table 03V Restriction upper arteries has received an additional option for device, H Intraluminal Device, Flow Diverter, for the intracranial artery, common carotid arteries, and vertebral arteries.

The following tables have qualifier 6 Bifurcation deleted from the qualifier choices; however, it does remain an option for the coronary artery in Tables 027 and 02C:

Table 047 Dilation lower arteries

Table 04C Extirpation lower arteries

Table 04V Restriction lower arteries

Table 06L Occlusion lower veins has body part 2 Gastric Vein moved to the next section on the table that includes additional approach options of 7 Via Natural or Artificial Opening and 8 Via Natural or Artificial Opening, Endoscopic.

Table 09U Supplement ear, nose, sinus has additional body part options added for the specific area of the sinuses. Body part L Nasal Turbinate is moved to the section with the specific sinuses.

Table 0JP Removal device subcutaneous tissue and fascia body part T Subcutaneous Tissue and Fascia, Trunk, has an additional device choice of Device F Subcutaneous Defibrillator Lead.

Table XW0 New technology introduction body part 1 Subcutaneous Tissue is added to create XW013W5 Introduction Caplacizumab subcutaneous tissue percutaneous, New Technology Group 5. Caplacizumab is a medication for treatment of thrombotic thrombocytopenic purpura and thrombosis) and New Technology Group 5 is added as a qualifier option for Peripheral Vein, Percutaneous; Central Vein, Percutaneous; and Mouth and Pharynx, External.

Table XT2 is a new table for 2020, adding XT25XE5 New technology, urinary system, monitoring, kidney, external, fluorescent Pyrazine, New Technology Group 5.

Table XXE is a new table for 2020, adding code XXE5XM5 New technology physiological systems measurement, circulatory, external approach, infection whole blood nucleic acid-base microbial detection, New Technology Group 5.

Revisit Revised Codes

There were only two revisions for this 2020 update. They are found in New Technology:

XW03372 Introduction coagulation factor Xa inactivated, peripheral vein, percutaneous approach, New Technology Group 2

XW04372 Introduction coagulation factor Xa inactivated, central vein, percutaneous approach, New Technology Group 2

The Index has several interesting revisions, which will require you to understand the exact intent of the procedure being performed. For example, starting Oct. 1, ablation guides you to whether it is for control of bleeding or destruction:

Ablation
See Control bleeding in
See Destruction

The intent guides us in the appropriate direction: whether it is to control bleeding in a body system or organ, such as the peritoneal cavity (Table 0W3), or to scar or destroy the tissue such as in coronary ablation (Table 025) or cervical ablation (Table 0U5).

Dilation Lower Artery now has further guidance added for if it is a sustained release drug-eluting intraluminal device(s). For example:

Femoral 047L – no change, for drug-eluting stent (DES), balloon, etc.

If it is a sustained release DES, you are directed to X27.

Review New Guidelines

In response to public comment, new guidelines have been added to the 2020 ICD-10-PCS Official Guidelines for Coding and Reporting for Radiation Therapy Section Guidelines (section D), New Technology is now guideline E:

D. Radiation Therapy Section

Brachytherapy

D1a. Brachytherapy is coded to the modality Brachytherapy in Radiation Therapy section. When a radioactive brachytherapy source is left in the body at the end of the procedure, it is coded separately to the root operation Insertion with the device value Radioactive Element.

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. 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.

Exception: Implantation of Cesium-131 brachytherapy seeds embedded in a collagen matrix to the treatment site after resection of brain tumor is coded to the root operation Insertion with the device value Radioactive Element, Cesium-131 Collagen Implant. The procedure is coded to the root operation Insertion only, because the device value identifies both the implantation of the radioactive element and a specific brachytherapy isotope that is not included in the Radiation Therapy section tables.

D1.b

A separate procedure to place a temporary applicator for delivering the brachytherapy is coded to the root operation Insertion and the device value Other Device.

Examples: Intrauterine brachytherapy applicator placed as a separate procedure from the brachytherapy procedure is coded to Insertion of Other Device, and the brachytherapy is coded separately using the modality Brachytherapy in the Radiation Therapy section. Intrauterine brachytherapy applicator placed concomitantly with delivery of the brachytherapy dose is coded with a single code using the modality Brachytherapy in the Radiation Therapy section.

There is also an addition to the New Technology guidelines: Guideline D1 is resequenced in guideline E1.a and there is an additional guideline added at E1.b:

New Technology Section Guidelines (section X)

E. New Technology Section

General guidelines

E1.a

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. When section X contains a code title which fully describes a specific new technology procedure, and it is the only procedure performed, only the section X code is reported for the procedure. There is no need to report an additional code in another section of ICD-10-PCS.

Example: XW04321 Introduction of Ceftazidime-Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1, can be coded to indicate that Ceftazidime-Avibactam Anti-infective was administered via a central vein. A separate code from table 3E0 in the Administration section of ICD-10-PCS is not coded in addition to this code.

E1.b

When multiple procedures are performed, New Technology section X codes are coded following the multiple procedures guideline.

Examples: Dual filter cerebral embolic filtration used during transcatheter aortic valve replacement (TAVR), X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2, is coded for the cerebral embolic filtration, along with an ICD-10-PCS code for the TAVR procedure.

Magnetically controlled growth rod (MCGR) placed during a spinal fusion procedure, a code from table XNS, Reposition of the Bones is coded for the MCGR, along with an ICD-10-PCS code for the spinal fusion procedure.

The guidelines are available as a downloadable PDF.

More to Come

These are just some of the changes for 2020. Be sure to review all the ICD-10-PCS guidelines and code set updates annually so you are accurately coding these procedures to the fullest specificity available. You’ll find the latest updates.

Certified Inpatient Coder CIC

Kimberly Farley, CIC, COC, CPC, CHONC, is an inpatient coder for Memorial Health System in Marietta, Ohio. She has worked in healthcare for 21 years, initially in a surgical practice before transferring to the HIS department of the health system. Farley is the 2019 education officer for the Parkersburg, W. Va., local chapter. She served as member development officer in 2011 and 2012 and has presented at chapter meetings.

Kimberly Farley

Kimberly Farley

Kimberly Farley, CIC, COC, CPC, CHONC, AAPC Fellow, is an inpatient coder for Memorial Health System in Marietta, Ohio. She has been in healthcare for 20 years. She served as member development officer in 2011 and 2012 for the Parkersburg, W.Va., local chapter and has presented at chapter meetings.
Kimberly Farley

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