Synopsis of ICD-10-PCS Codes & Guidelines for FY 2023

Overview

Centers for Medicare & Medicaid Services; CMS has released the FY 2023 ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) codes and guidelines which are effective till September 30, 2023. We will be following these guidelines for another three Quarters. This article will give you a synopsis of the updates.

Major updates are in the below sections:

1. Medical and surgical.

2. Administrative.

3. Extracorporeal or systemic assistance and performance.

4. New technology.

ICD-10-PCS Guideline Updates:

Detachment of extremities: B3.19

The root operation “Detachment” contains qualifiers that can be used to specify the level where the extremity was amputated. These qualifiers are dependent on the body part value in the “upper extremities” and “lower extremities” body systems.

For procedures involving the detachment of all or parts of the upper or lower extremities, the procedure code to the body part value describes the site of the detachment. 

When coding amputation of hand & foot, the following definitions are followed.

Complete: Amputation through the carpometacarpal joint of the hand or through the tarsal-metatarsal joint of the foot.

Partial:  Amputation anywhere along the shaft or head of the metacarpal bone of the hand, or of the metatarsal bone of the foot.

Vascular Procedures - General guideline - B4.1c 

If a single vascular procedure is performed on a continuous section of an arterial or venous body part, code the body part value corresponding to the anatomically most proximal (closest to the heart) portion of the arterial or venous body part

Device Value - General guideline - B6.1a

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. If a device that is intended to remain after the procedure is completed requires removal before the end of the operative episode in which it was inserted (for example, the device size is inadequate or an event documented as a complication occurs), both the insertion and removal of the device should be coded.

ICD-10-PCS Code Set Updates

Laser Interstitial Thermal Therapy: (LITT)

These codes were deleted from radiological sections and added to medical-surgical sections with respect to body parts.

This change was made because the procedure does not use ionizing radiation but rather thermal therapy to destroy soft tissue using heat generated by a laser probe

The codes are now added as Destruction procedures in the Medical and Surgical section in applicable body systems, with the LITT reflected in the qualifier value

Example: LiTT may be appropriate for some people with focal seizures, which are seizures coming from one region of the brain.

Code effective before 1st OCT 2022 - D0Y0KZZ - Laser Interstitial Thermal Therapy of Brain

Code effective after 1st OCT 2022 -  00504Z3 -   Destruction of Brain using Laser Interstitial Thermal Therapy, Percutaneous Endoscopic Approach

Spinal Fusion With Interbody Device:

Joint fusions using a nanotextured surface interbody or a radiolucent porous interbody fusion device codes were deleted from the new technology section and moved to respective medical and surgical sections of upper or lower joints fusion.

A spinal fusion procedure is done for diagnosis related to the vertebral column such as disc degeneration, curvature issues, spinal stenosis, and disc displacement. 

Code effective before 1st OCT: XRGB092-  Fusion of Lumbar Vertebral Joint using Nanotextured Surface Interbody Fusion Device, Open Approach, New Technology Group 2

Code effective after 1st OCT: 0SG30A0- Fusion of Lumbosacral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach

Extracorporeal supersaturated oxygenation:

Extracorporeal supersaturated oxygenation (intermittent and continuous) procedure new duration value added in the Extracorporeal or Systemic Assistance and Performance Physiological Systems Assistance PCS table identifies cardiac perfusion with intra-arterial supersaturated oxygen.

This is a novel therapy that complements PCI for treating an acute heart attack. It is designed to restore microvascular blood flow and reduce damage to the heart muscle to improve overall heart function.

Rapid Deployment of heart valve

Replacement of aortic valves using the rapid deployment technique: These procedures have moved from the New Technology Cardiovascular System Replacement PCS table to the Medical and Surgical Heart and Great Vessels Replacement PCS table.

The rapid-deployment valve system (RDVS) was introduced to the facility for minimally invasive aortic valve replacement to treat diagnoses such as heart valve stenosis, and insufficiency.

Code effective before 1st OCT: X2RF032 - Replacement of Aortic Valve using Zooplastic Tissue, Rapid Deployment Technique, Open Approach, New Technology Group 2

Code effective after 1st OCT - 02RF08N - Replacement of Aortic Valve with Zooplastic Tissue, using Rapid Deployment Technique, Open Approach

Replacement of skin with substitute

Replacement of skin using a porcine liver-derived skin substitute procedure code moved from the new technology section to the medical & surgical section, skin and breast body system with device value as nonautologous.

In extensive deep burns and other full-thickness skin wounds, permanent replacement of lost skin remains a major challenge. Porcine skin is already used clinically to provide physiologic coverage for skin wounds; because it is structurally and immunologically similar to human skin

Code effective before 1st OCT: XHRPXL2 - Replacement of Skin using Porcine Liver Derived Skin Substitute, External Approach, New Technology Group 2

Code effective after 1st OCT - 0HR5XK3 -Replacement of Chest Skin with Nonautologous Tissue Substitute, Full Thickness, External Approach

Introduction of Concentrated Bone Marrow Aspirate to Muscle

The introduction of bone marrow into the muscle procedure moved from the New Technology Muscles, Tendons, Bursae, and Ligaments section to the Administration Physiological Systems and Anatomical Regions with qualifier as “other substances”

Concentrated bone marrow aspirate (cBMA) provides both stem cells and growth factors and relies on the host tissue to provide scaffold. The use of cBMA has become an increasingly popular alternative and adjunct in the treatment of cartilaginous lesions, bony defects, and tendinous injuries.

Code effective before 1st OCT: XK02303- Introduction of Concentrated Bone Marrow Aspirate into Muscle, Percutaneous Approach, New Technology Group 3 

Code effective after 1st OCT - 3E023GC - Introduction of Other Therapeutic Substance into Muscle, Percutaneous Approach

Conclusion

That was about the ICD-10-PCS Codes & Guidelines for FY 2023. Not just this, CMS is implementing 34 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) which will be effective from April 01, 2023. Stay tuned for this update in the coming month. 

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Reference: 

https://www.healthcatalyst.com/insights/changes-icd-10-pcs-codes-cms-updates-effective-october-2022#new-technology

https://www.cms.gov/files/document/2023-official-icd-10-pcs-coding-guidelines.pdf

https://www.cms.gov/medicare/icd-10/2023-icd-10-pcs