By Cari Greenwood, RHIA, CCS, CPC, CICA
The updates to ICD-10-PCS for fiscal year 2022 were released by the Centers for Medicare and Medicaid Services (CMS) in June 2021. One hundred ninety-one new codes were introduced, and 107 codes were deleted, for a net increase of 84 codes over the total for 2021. Additionally, 62 codes had revisions made to their titles.
This article will provide a summary of some notable changes.
Changes to ICD-10-PCS Tables
There are 40 ICD-10-PCS tables that experienced changes for 2022. Additions to the tables in the Medical and Surgical Section are noted below by body system.
- Central Nervous System and Cranial Nerves
- 00D – Body part character values 0 Brain and 7 Cerebral Hemisphere were added for the root operation Extraction.
- Heart and Great Vessels
- 02C – Qualifier value 7 Orbital Atherectomy added for the Coronary Artery body parts and the root operation Extirpation.
- 02F – Coronary Artery body part character values 0-3 were added for the root operation Fragmentation.
- 02R – Body part character value A Heart and device character values L Biologic with Synthetic Substitute, Autoregulated Electrohydraulic and M Synthetic Substitute, Pneumatic were added, as well as Qualifier values L In Existing Conduit and M Native Site, which were added for the body part Pulmonary Valve and the root operation Replacement.
- 02V – Body part character value L Ventricle, Left was added for the root operation Restriction.
- Upper Arteries
- 031 – Approach value 3 Percutaneous was added for the Brachial Artery, Right and Brachial Artery, Left body parts and the root operation Bypass.
- 03F – Body part character value G Intracranial Artery was added for the root operation Fragmentation.
- Lower Veins
- 031 – Approach values 7 Via Natural or Artificial Opening and 8 Via Natural or Artificial Opening were added for the Lower Vein body part and the root operation Occlusion.
- Lymphatic and Hemic Systems
- 07D – Body part value T Bone Marrow (with no further designation as to site) was added for the root operation Extraction.
- Hepatobiliary System and Pancreas
- 0F8 – Body part values 0 Liver, 1 Liver, Right Lobe, and 2 Liver, Left Lobe were added for the root operation Division.
- 0K8 – Approach values 7 Via Natural or Artificial Opening and 8 Via Natural or Artificial Opening were added for the Tongue, Palate, and Pharynx Muscle body part and the root operation Division.
- Head and Facial Bones
- 0NH – Device character value 3 Infusion Device was added for the body part Skull and the root operation Insertion.
- Upper Bones
- 0PS – Device character value 3 Spinal Stabilization Device, Vertebral Body Tether was added for the body part Thoracic Vertebra and the root operation Reposition.
- Lower Bones
- 0QB – Qualifier value 2 Sesamoid Bone(s) 1st Toe was added for the Metatarsal, Right, and Left body parts and the root operation Excision.
- 0QS – Device character value 3 Spinal Stabilization Device, Vertebral Body Tether was added for the body part Lumbar Vertebra and the root operation Reposition.
- Upper Joints
- 0RP/0RW – Qualifier values 6 Humeral Surface and 7 Glenoid Surface were added for the Shoulder Joint, Right, and Left body parts and the root operations Removal and Revision.
- The value of “Open” has been removed as an option for the Approach character in table 302, Administration, Circulatory, Transfusion.
- “Automated” is now an option for the Qualifier value for the Cardiac body system in table 5A1, Extracorporeal or Systemic Assistance and Performance, Physiological Systems, Performance.
- For 2022, Qualifier value 7 New Technology Group 7 is used for all new codes in the New Technology section of PCS. This group brings the addition of over 50 new devices, substances, or technologies. These can be reviewed by locating the rows of the tables in the New Technology section with 7 as the Qualifier value. The inclusion of some procedures required the addition of tables corresponding to the root operations they are reported with. The specific root operations are detailed in the next section.
Additions to the ICD-10-PCS Definitions
Several additions were made to the ICD-10-PCS Definitions, some of which are outlined here.
The following were added as anatomic sites that are included under the indicated ICD-10-PCS body part character value in the Medical and Surgical Section of PCS.
|ICD-10-PCS Body Part Character Value||Anatomic Site|
|Spinal Cord||Dorsal Root Ganglion|
|Cervical Spinal Cord|
|Thoracic Spinal Cord|
|Lumbar Spinal Cord|
|Metatarsal, Left||Fibular Sesamoid|
|Metatarsal, Right||Tibial Sesamoid|
The addition of certain procedures to the New Technology Section of PCS necessitated adding the following ICD-10-PCS root operation character values to the New Technology Section of PCS.
Device Aggregation Table
The specific device values: Spinal Stabilization Device and Vertebral Body Tether have been added to the Device Aggregation Table to correspond with the general device value; Internal Fixation Device. These devices are for use with Reposition procedures performed in the Lower and Upper Bones body systems, as mentioned earlier.
In addition, many substances and devices were added to the ICD-10-PCS definitions. The full list of additions can be reviewed here: definitions_addenda_2022.pdf
Changes to the ICD-10-PCS Alphabetic Index
The majority of updates to the ICD-10-PCS Alphabetic Index correspond to the addition of codes for new procedures, such as computer-aided mechanical aspiration, which was added to the New Technology section, the addition of new character value options or additions to the ICD-10-PCS definitions.
For example, a main term entry of Dorsal root ganglion with subterm entries of “use Spinal Cord, use Cervical Spinal Cord, use Thoracic Spinal Cord and use Lumbar Spinal Cord” are available to coincide with the addition of Dorsal root ganglion to the ICD-10-PCS Body Part definitions.
Dorsal root ganglion
use Spinal Cord
use Cervical Spinal Cord
use Thoracic Spinal Cord
use Lumbar Spinal Cord
Although consulting the Alphabetic Index is not necessary to build a valid PCS code, it can be an especially helpful resource when you aren’t sure how the terms in your documentation translate into PCS character values. This makes now a good time to for you to review the changes in the addenda to the index to see what new tidbits you can pick up.
The addenda to the Alphabetic Index can be found here: index_addenda_2022.pdf
Changes to the ICD-10-PCS Guidelines
There were no new ICD-10-PCS guidelines introduced for 2022, but five existing guidelines were updated. One of the Root Operation guidelines (B3.7) and two of the Body Part guidelines (B4.1c and B4.8) received changes, as well as both guidelines for the New Technology section (E1.a, b).
B3.7 Control vs. more specific root operations
Language has been added to this guideline to clarify that the root operation “Control” is assigned when a procedure performed to achieve hemostasis utilizes techniques that go beyond what is considered integral to the procedure and the procedure is not described by a more specific root operation.
Additionally, the updates to this guideline include new examples with scenarios illustrating when a procedure with the root operation “Control” should be assigned, when control of bleeding is integral to the procedure, and when a procedure with a root operation other than “Control” should be reported.
B4.1c Body Part – General guidelines
This guideline has been changed to identify the correct body part assigned when a procedure is performed on a continuous section of a tubular body part, such as an artery or the colon, as the one that is “… anatomically most proximal (closest to the heart) portion of the tubular body part” rather than “… the furthest anatomical site from the point of entry” as stated in the ICD-10-PCS Guidelines for FY 2021.
The example for this guideline has been updated as well and should be reviewed carefully, because the change in guidance means the heart, rather than point of entry, is now the reference point for determining the correct body part character value for these procedures. Thus, if the entry point for a procedure is the anatomically most proximal portion of the tubular body part, the body part character value for the entry point should be assigned.
B4.8 Upper and lower intestinal tract
The changes to this guideline consist of the addition of the root operation “Insertion” to the list of root operations for which the general body part values Upper and Lower Intestinal Tract, in the Gastrointestinal body system, are provided.
E1.a New Technology – General guidelines
The example of application included with this guideline was updated to change code XW04321, which is from New Technology Group 1 to XW043A6 from New Technology Group 6. The guidance provided by the guideline has not changed.
E1.b New Technology – General guidelines
This guideline was updated to replace placement of magnetically controlled growth rods during spinal fusion with placement of an extracorporeal flow reversal circuit for embolic neuroprotection during a transcarotid arterial revascularization procedure as the second example of application of this guideline. The guidance provided by the guideline has not changed.
Although the change to the number of ICD-10-PCS codes was not drastic for FY 2022, some of the updates fundamentally change the way certain procedures are coded, either through the addition of new PCS character values or the application of new guidance. So, be sure to take the time to identify the changes that will have a direct impact on your day-to-day coding and the way your organization reports certain procedures.
Cari Greenwood is an independent coding consultant.
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