Inpatient Facility Coding & Compliance Alert

Watch for revised rules for multiple procedures, root operations, body parts, and more.

The ICD-10-PCS codes update for fiscal year FY2017 brings you 3,651 new and 487 revised PCS codes to learn about.

“I think that most coding personnel will look at new codes and coding guidelines,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. Furthermore, “the impact of DRG changes (e.g., CC and MCC listings) will probably be studied retrospectively, that is, when there are strange grouping outcomes that are different from the current groupings.”

Among the other changes, here is a quick glance at the revisions to the official ICD-10-PCS Coding Guidelines B3.11b, B3.4a, B3.2b, and B4.1b, in response to public comment.

Guideline B3.2b: The revised guidelines for root operations involving multiple procedures state that you may report multiple procedures during the same operative episode, if the same root operation is being repetitively performed in multiple body parts. The body parts must be separate and distinct, although classified within a single ICD-10-PCS body part value.

Example: An excision of the Gracilis muscle and excision of the Sartorius muscle can both be included within the upper leg muscle body part value. You can thereby code multiple procedures here.

Guideline B3.4a: The revised guidelines for the root operation involving biopsy procedures state that biopsy procedures are to be coded using the root operations excisions, extraction, or drainage, and the qualifier “diagnostic.”

Examples:

• Fine needle aspiration biopsy (FNAC) of lungà root operation drainage, qualifier diagnostic
• Biopsy of bone marrowà root operation extraction, qualifier diagnostic.
• Lymph node sampling for biopsyà root operation excision, qualifier diagnostic.

Guideline B3.11b: The revised guidelines for root operations involving inspection procedures state that if multiple tubular body parts are inspected, the most distal body part, or the part farthest from the starting point of inspection, is to be coded.

Example: If a provider performs cystoureteroscopy (i.e., inspection of the bladder and ureters), the ureters will be coded as the body part value.

Guideline B4.1b: The revised general guidelines for body parts state that if the prefix “peri” is attached to a body part, with no further information regarding the site, then you may code the procedure based on the body part named. This applies only when the particular body part is not specified.

Example: If a procedure is mentioned to take place in perirenal area, you may code it to the body part kidney, if the documentation does not provide you with any further clue.

The road ahead: As AHIMA says, you must use well this interim interval preceding the final implementation of the new codes, and make the most of the time available.

“Care must be taken to study and digest as much as possible relative to a given person’s job function,” advises Abbey. “Unfortunately, we will all have to learn on the job to some extent. Of concern is that the overhead for coding personnel will be increased for a period of time. At the rate we are going, things will just keep getting more complex and while we will code to the best of our ability, the DRG grouper is going to be more of a black-box in that we will not really know how it operates without getting into the program specifications.”