Inpatient Facility Coding & Compliance Alert

Majority of code overhaul comes from the cardiovascular system.

The ICD-10 codes are finally ready for updating, after a five-year ICD-10 classification system freeze. This October 1, 2016, the first set of ICD-10 annual updates shall be released. “Change seems to be the name of the game,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA.

CMS released 3,651 ICD-10-PCS codes and CDC released 1,943 new ICD-10-CM codes. Following a public review period, once finalized, these codes shall apply from Oct. 1, 2016.

Further, the ICD-10 Coordination and Maintenance Committee reviewed proposals for the updating of ICD-10-CM and PCS. If approved, these would be included in the Oct. 1, 2017, classification system addenda for FY 2018.

Apart from the addition of new codes, the updates will also include 351 code revisions and 313 code deletions in ICD-10 PCS. In addition, 422 codes revisions and 305 deletions are due in ICD-10-CM.

The premise for updates is that the new codes encompass the recent advances and trends in healthcare. The new codes have arrived sooner than many would have expected, giving additional time to the industry, coders, and providers to assimilate the nuances of the new codes until this October.

Get a Sneak Peek at the New Arrivals

We currently have 75,625 ICD-10-PCS codes in total, including 3,651 new codes and 487 revised codes. The majority of the new codes (some 3,549 codes) belong to the cardiovascular system. These relate to:

• Unique device values
• Addition of bifurcation as a qualifier
• Additional specific body parts
• Congenital cardiac procedures
• Placement of intravascular neurostimulators.

As for the revised PCS codes, most of them relate to:

• Change in the number of coronary artery sites to the number of vessels
• Specification of the descending aorta.

Furthermore, additional new codes pertain to unilateral knee replacement and detailing of the body part in removal and revision of lower joints.

The committee received 13 new PCS code proposals relating to a New Technology section, including spinal fusion with Titan Spine EndoSkeleton nanoLOCK^TM, administration of Andexanet Alfa, GORE^® EXCLUDER Iliac Branch Endoprosthesis, insertion of endobronchial coils, and more.

There were 24 diagnosis proposals on the agenda for discussion such as:

• Clostridium Difficile: A proposal was presented to expand the code to differentiate recurrent c. diff. enterocolitis from enterocolitis not specified as recurrent.
• Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked.
• Myocardial infarction: Specify the types as defined by several professional cardiology organizations. A specific code was proposed for type 2 myocardial infarction due to demand ischemia or ischemic imbalance so that data can be captured. The additional myocardial infarction types (3, 4a, 4b, 4c, 5) would all be assigned to one ICD-10-CM code. There was much discussion on this proposal related to the code proposals as well as the indexing and impact on subsequent myocardial infarctions. This proposal was requested for inclusion in the 10/1/16 addenda.
• Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda which would be consistent with the World Health Organization (WHO).

Hook Yourself Up With Links and Timelines

The proposed ICD-10-PCS codes are available at: https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html.

Start preparing: “While physicians, practitioners, and coding staff are all still acclimating to ICD-10 coding, we must use the next several months to refine the coding process through ongoing training efforts,” suggests Abbey. “Particularly in the cardiology area, many, if not most, hospitals provide various levels of service that will be affected by these changes.”