ICD 10 Coding Alert

Your cardiac codes will be vastly affected by “Creation.”

The countdown to ICD-10-PCS 2017 is on, bringing a grand total of 75,789 codes. While you’re checking out the 3,827 new codes in the code set, be sure to take note of some revisions and additions to root operation definitions, which are associated with a code’s third character. Let’s take a look at Medical and Surgical changes to include in your PCS prep.

Dates: Use 2017 ICD-10-PCS code for discharges from Oct. 1, 2016, to Sept. 30, 2017.

Expand Control Beyond Postprocedural

In Section 0, Medical and Surgical, ICD-10-PCS 2017 updates the Definition and Includes/Examples listings for the operation known as Control.

2017 Definition (new words underlined): Stopping, or attempting to stop, postprocedural or other acute bleeding

The addition of those three little words, “or other acute,” significantly broadens the applicability of this operation, as you can see by the nature of the examples added for 2017.

2017 Includes/Examples (new words underlined, deleted words crossed through): Control of post-prostatectomy hemorrhage, control of post-tonsillectomy hemorrhage control of intracranial subdural hemorrhage, control of bleeding duodenal ulcer, control of retroperitoneal hemorrhage

Wider impact: The 2017 ICD-10-PCS Index will change the entry for “Control postprocedural bleeding in” to “Control bleeding in,” removing the term postprocedural. Tables will see a change in line with this update, too. For instance, the table for 0W3 (Anatomical Regions, General, Control) will show the new definition of Control that makes it clear it applies to other acute bleeding in addition to postprocedural bleeding.

Include Congenital Anomalies in Creation

You also need to watch for major changes in Section 0, Medical and Surgical, for the operation known as Creation. Pay particular attention to the Explanation section below to get the gist of the update. The changes are so sweeping that it helps to see the 2016 and 2017 entries side by side.

2016 Definition: Making a new genital structure that does not take over the function of a body part

2017 Definition: Putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part

2016 Explanation: Used only for sex change operations

2017 Explanation: Used for gender reassignment surgery and corrective procedures in individuals with congenital anomalies

2016 Includes/Examples: Creation of vagina in a male, creation of penis in a female

2017 Includes/Examples: Creation of vagina in a male, creation of right and left atrioventricular valve from common atrioventricular valve

Examples: For Creation, ICD-10-PCS 2017 will offer codes starting with 024F0 for an aortic valve, 024G0 for a mitral valve, and 024J0 for a tricuspid valve.

Don’t Miss the Other Root Updates

We’ve taken a close look at changes to Control and Creation for Medical and Surgical, but there are other root operation changes, too.

Section 6, Extracorporeal Therapies, adds Perfusion, defined as “Extracorporeal treatment by diffusion of therapeutic fluid.”

And you’ll see existing operations added for Section X, New Technology:

• Assistance
• Fusion
• Insertion
• Removal
• Replacement
• Reposition
• Revision.

Resource: To review the definitions for these Section X changes, head to the CMS ICD-10 PCS and GEMs page. To see only changes, download the 2017 ICD-10-PCS Addendum. URL: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html

Correction note: You should use this article as your ICD-10-PCS guide instead of the ICD-10 Coding Alert version 6 number 9 article, “Get Ready to Report 9 New Root Operations,” as this contains misinformation. You’ll only have one brand new root operation, which is Perfusion, and two root operation revisions. You’ll add the nine pre-existing root operations as coding possibilities in Section X.

Finally, the chart is incorrect. An approach is not the same as a root operation. The “Via Natural or Artificial Opening” and “Via Natural or Artificial Opening Endoscopic” are merely approaches and should be reflected in the last character, not operations (which are character 3).