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Coding Tip of the Month – August 2018

FY 2019 ICD-10-PCS Updates

It is time once again to prepare for the annual code updates. The table below summarizes the October 1st, 2018 updates for both CM and PCS.

New Codes Deleted Codes Revised Codes
ICD-10-CM 247 49 139
ICD-10-PCS 392 216 8

The synopsis below highlights just some of the PCS changes for commonly reported procedure codes by Section and Body System.

Medical and Surgical Section:

Ears, Nose, Sinus (9)

A new table for the root operation Control has been established to describe control of epistaxis from the nasal mucosa or soft tissue. The change is significant in that prior to this update, the root operation Control was only available within the Anatomic Regions body systems in ICD-10-PCS. This addition is intended to distinguish procedures performed to control epistaxis from procedures to control bleeding elsewhere in the respiratory tract.

Body System
0 Medical and Surgical
9 Ear, Nose, Sinus
3 Control Stopping or attempting to stop postprocedural or other acute bleeding
Body Part Approach Device Qualifier
K Nasal Mucosa and Soft Tissue 7 Via Natural or Artificial Opening
8 Via Natural or Artificial Opening Endoscopic
Z No Device Z No Qualifier

Upper (R) & Lower Joints (S)

Coding spinal fusion procedures remains one of the more challenging areas in PCS coding. Annual updates, both last year and this year, have provided changes to the PCS tables to help ensure coding and DRG accuracy. Last year the tables provided a new, separate row in the tables ORG and OSG for the device character “Interbody Fusion Device (A)” so the only valid qualifiers included the anterior column. An interbody fusion device is placed between two vertebral bodies which by definition is the anterior column. These resulted in the deletion of 33 procedure codes that were clinically invalid. For FY 2019 revisions have again been made to tables ORG and OSG by removing the device character “No Device (Z)”. Because a spinal fusion procedure always requires some type of device codes with the device character “Z – No Device” are considered clinically invalid. This will result in the deletion of 99 spinal fusion codes for FY 2019.

Lower Joints (S)

New and revised device characters applicable to the Knee Joints have been established for FY 2019 to enable the capture of additional detail for knee arthroplasty procedures. These device characters can be found under the root operation Replacement and Removal.

FY 2018 Device Characters FY 2019 Device Characters
E Articulating Spacer
L Synthetic Substitute, Unicondylar L Synthetic Substitute, Unicondylar Lateral
M Synthetic Substitute, Unicondylar Medial
N Synthetic Substitute Patellofemoral

Obstetrics Section:

Pregnancy (0)

The qualifiers to describe the location of the incision made during a cesarean delivery on Table 10D have been revised for October 1st, 2018. This change will facilitate the appropriate classification of cesarean delivery procedures.

FY 2018 Qualifiers FY 2019 Qualifiers
0 Classical 1 Low Cervical
0 High 1 Low