2017 ICD 10 PCS Code Updates

Transcription

1 2017 ICD 10 PCS Code Updates Kimberly Cunningham CPC, CIC, CCS Copyright/Disclaimer text

2 No part of this presentation may be reproduced or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or taping) without the expressed written permission of AAPC. 2

3 ICD 10 PCS Code changes for 2017 Total number of PCS codes in 2016: 71,974 3,827 new procedure codes 491 revised codes 12 deleted codes Total number of PCS codes in 2017: 75,789 3

4 ICD 10 PCS Update Highlights In the Medical and Surgical sections, revisions to the definitions of the root operations for Control and Creation procedures Addition of Transplantation procedure codes for Face and Hand Transplants In the Extracorporeal Therapies section in the Medical and Surgical related procedures, addition of a new root operation Perfusion Addition of codes for Assistance, Replacement, Reposition, Fusion, and Introduction have been added to the New Technology Section Revision of ICD 10 PCS guidelines Coding Updates Character value additions New file available for ICD 10 PCS, Code conversion table 4

5 2017 ICD 10 PCS Updates Root Operation Updates Copyright/Disclaimer 2014 AAPC text

6 Root Operation - Control CMS has updated the definition of the Root operation - Control. Prior to the 2017 updates, the root operation, Control was only to be used with postprocedural bleeding. With the update to the definition for the 2017 ICD 10 PCS code set, control can now be used in situations of other acute bleeding. The updated definition of the root operation, Control is now defined as stopping, or attempting to stop, postprocedural or other acute bleeding. 6

7 Root Operation - Creation CMS has updated the definition of the Root operation - Creation. Prior to the 2017 updates, the root operation Creation was only to be used for sex change operations. With the update to the definition for the 2017 ICD 10 PCS code set, creation can now be applied to other body systems. The updated definition of the root operation, Creation is 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. 7

8 New Root Operation - Perfusion Extracorporeal Therapies section Section 6 Perfusion is extracorporeal treatment by diffusion of therapeutic fluid. Perfusion codes are used with donor organs. Fluid is pumped through the organ to preserve it. Example: 6AB50BZ Perfusion of Circulatory Donor Organ, Single 8

9 2017 ICD 10 PCS Updates Guideline Updates Copyright/Disclaimer text

10 Changes to the Official ICD 10 PCS Coding Guidelines Specific changes occurred to the following Guidelines: Changes that were made to the ICD 10 PCS guidelines are in response to public comment and Cooperative Parties review. B2.1a B3.2 B3.4a B3.6b B3.7 B3.9 B4.2 B4.4 10

11 B2.1a General Guidelines 2016 Guideline B2.1a The procedure codes in the general anatomical regions body systems should only be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, Drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part. Example: Control of postoperative hemorrhage is coded to the root operation Control found in the general anatomical regions body systems. 11

12 B2.1a General Guidelines What s new for 2017??? The guideline was changed to read that the anatomical regions body systems can be used when the procedure is performed on an anatomical region rather than a specific body part. Examples of a Chest tube drainage of the pleural cavity coded to the root operation Drainage found in the general anatomical regions body systems. Reference Drainage, then Pleural Cavity to locate the first four characters of the PCS code. Also an example of suture repair of the abdominal wall is coded to the root operation Repair in the general anatomical regions body system. Reference Repair, then abdominal wall. 12

13 B2.1a General Guidelines 2017 Guideline B2.1a The procedure codes in the general anatomical regions body systems can be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, Drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part. Examples: Control of postoperative hemorrhage is coded to the root operation Control found in the general anatomical regions body systems. Chest tube drainage of the pleural cavity is coded to the root operation Drainage found in the general anatomical regions body systems. Suture repair of the abdominal wall is coded to the root operation Repair in the general anatomical regions body system. 13

14 B3.2 Multiple Procedures 2016 Guideline During the same operative episode, multiple procedures are coded if: a. The same root operation is performed on different body parts as defined by distinct values of the body part character. Example: Diagnostic excision of liver and pancreas are coded separately. b. The same root operation is repeated in multiple body parts, and those body parts are separate and distinct body parts classified to a single ICD-10-PCS body part value. Example: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the upper leg muscle body part value, and multiple procedures are coded. c. Multiple root operations with distinct objectives are performed on the same body part. Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately. d. The intended root operation is attempted using one approach, but is converted to a different approach. Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection. 14

15 B3.2 Multiple Procedures What s new for 2017??? An additional example is added for root operations performed on different body parts with distinct character values during the same operative episode. The new example provided is that of a resection of a lesion of the ascending colon and an excision of a lesion of the transverse colon. A code for each excision procedure can be coded because the body parts are represented with distinct character values. The ascending colon is represented by body part character K under the root operation Excision, and the transverse colon is represented by body part character L. An additional example is provided to guidance on the proper coding of multiple procedures repeated on multiple body parts during the same operative episode. The example of Extraction of multiple toenails is represented with a separate code for each toenail removed. 15

16 B3.2 Multiple Procedures 2017 Guideline During the same operative episode, multiple procedures are coded if: a. The same root operation is performed on different body parts as defined by distinct values of the body part character. Examples: Diagnostic excision of liver and pancreas are coded separately. Excision of lesion in the ascending colon and excision of lesion in the transverse colon are coded separately. b. The same root operation is repeated in multiple body parts, and those body parts are separate and distinct body parts classified to a single ICD-10-PCS body part value. Examples: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the upper leg muscle body part value, and multiple procedures are coded. Extraction of multiple toenails are coded separately. c. Multiple root operations with distinct objectives are performed on the same body part. Example: Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately. d. The intended root operation is attempted using one approach, but is converted to a different approach. Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection. 16

17 B3.4a Biopsy procedures 2016 Guideline Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. Examples: Fine needle aspiration biopsy of lung is coded to the root operation Drainage with the qualifier Diagnostic. Biopsy of bone marrow is coded to the root operation Extraction with the qualifier Diagnostic. Lymph node sampling for biopsy is coded to the root operation Excision with the qualifier Diagnostic. 17

18 B3.4a Biopsy procedures What s new for 2017??? More specificity is provided for the biopsy in order to properly describe the procedure code for the first example of a fine needle aspiration of fluid in the lung. In the 2016 guidelines, the example stated that there was a fine needle aspiration of the lung, which would correctly code to the root operation Excision, not Drainage, however, both procedures would be reported with the 7 th character qualifier Diagnostic to identify that it is a biopsy procedure. 18

19 B3.4a Biopsy procedures 2017 Guideline Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. Examples: Fine needle aspiration biopsy of fluid in the lung is coded to the root operation Drainage with the qualifier Diagnostic. Biopsy of bone marrow is coded to the root operation Extraction with the qualifier Diagnostic. Lymph node sampling for biopsy is coded to the root operation Excision with the qualifier Diagnostic. 19

20 B3.6b Bypass Procedures 2016 Guideline Coronary arteries are classified by number of distinct sites treated, rather than number of coronary arteries or anatomic name of a coronary artery (e.g., left anterior descending). Coronary artery bypass procedures are coded differently than other bypass procedures as described in the previous guideline. Rather than identifying the body part bypassed from, the body part identifies the number of coronary artery sites bypassed to, and the qualifier specifies the vessel bypassed from. Example: Aortocoronary artery bypass of one site on the left anterior descending coronary artery and one site on the obtuse marginal coronary artery is classified in the body part axis of classification as two coronary artery sites and the qualifier specifies the aorta as the body part bypassed from. 20

21 B3.6b Bypass procedures What s new for 2017??? The first sentence of the guideline was removed. Coronary artery bypass procedures are coded differently than other bypass procedures as described in the previous guideline. 21

22 B3.6b Bypass procedures 2017 Guideline Coronary artery bypass procedures are coded differently than other bypass procedures as described in the previous guideline. Rather than identifying the body part bypassed from, the body part identifies the number of coronary arteries bypassed to, and the qualifier specifies the vessel bypassed from. Example: Aortocoronary artery bypass of the left anterior descending coronary artery and the obtuse marginal coronary artery is classified in the body part axis of classification as two coronary arteries, and the qualifier specifies the aorta as the body part bypassed from 22

23 B3.6c Bypass procedures 2016 Guideline If multiple coronary artery sites are bypassed, a separate procedure is coded for each coronary artery site that uses a different device and/or qualifier. Example: Aortocoronary artery bypass and internal mammary coronary artery bypass are coded separately. 23

24 B3.6c Bypass procedures What s new for 2017??? In the first sentence artery sites was changed to arteries. In the example provided, an aortocoronary bypass procedure is done during the same operative episode as an internal mammary coronary artery bypass procedure. Let s assume this is an open procedure. The correct coding for these procedures is: 02100AW Bypass Coronary Artery, One Site, from Aorta with Autologous Arterial Tissue, Open Approach 02100Z9 Bypass Coronary Artery, One Site, from Left Internal Mammary Artery, Open Approach 24

25 B3.6c Bypass procedures 2017 Guideline If multiple coronary arteries are bypassed, a separate procedure is coded for each coronary artery that uses a different device and/or qualifier. Example: Aortocoronary artery bypass and internal mammary coronary artery bypass are coded separately. 25

26 B3.7 Control vs. more definitive root operations 2016 Guideline The root operation Control is defined as, Stopping, or attempting to stop, postprocedural bleeding. If an attempt to stop postprocedural bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control. Example: Resection of spleen to stop postprocedural bleeding is coded to Resection instead of Control. 26

27 B3.7 Control vs. more definitive root operations What s new for 2017??? The guideline change now allows for the root operation of Control to be used for instances of postprocedural bleeding, as well as other acute bleeding. 27

28 B3.7 Control vs. more definitive root operations 2017 Guideline The root operation Control is defined as, Stopping, or attempting to stop, postprocedural or other acute bleeding. If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control. Example: Resection of spleen to stop postprocedural bleeding is coded to Resection instead of Control 28

29 B3.9 Excision for graft 2016 Guideline If an autograft is obtained from a different body part in order to complete the objective of the procedure, a separate procedure is coded. Example: Coronary bypass with excision of saphenous vein graft, excision of saphenous vein is coded separately. 29

30 B3.9 Excision for graft What s new for 2017??? The guideline now indicates that an autograft obtained from a different procedural site can be codes as a separate procedure. Different procedure site replaces the terms body part. 30

31 B3.9 Excision for graft 2017 Guideline If an autograft is obtained from a different procedure site in order to complete the objective of the procedure, a separate procedure is coded. Example: Coronary bypass with excision of saphenous vein graft, excision of saphenous vein is coded separately 31

32 B4.2 Branches of body parts 2016 Guideline Where a specific branch of a body part does not have its own body part value in PCS, the body part is coded to the closest proximal branch that has a specific body part value. Example: A procedure performed on the mandibular branch of the trigeminal nerve is coded to the trigeminal nerve body part value. 32

33 B4.2 Branches of body parts What s new for 2017??? Further specificity has been added to this guideline with specific reference to the cardiovascular system and the correct body part value. An additional example is provided to the guideline illustrating the application of the specificity that was added. In the example, there is Occlusion of the bronchial artery. This is coded to the body part value, Upper Artery, with the body system value Upper Arteries, and not to Thoracic Aorta, Descending in the Heart and Great Vessels. 33

34 B4.2 Branches of body parts 2017 Guideline Where a specific branch of a body part does not have its own body part value in PCS, the body part is typically coded to the closest proximal branch that has a specific body part value. In the cardiovascular body systems, if a general body part is available in the correct root operation table, and coding to a proximal branch would require assigning a code in a different body system, the procedure is coded using the general body part value. Examples: A procedure performed on the mandibular branch of the trigeminal nerve is coded to the trigeminal nerve body part value. Occlusion of the bronchial artery is coded to the body part value Upper Artery in the body system Upper Arteries, and not to the body part value Thoracic Aorta, Descending in the body system Heart and Great Vessels. 34

35 B4.4 Coronary arteries 2016 Guideline The coronary arteries are classified as a single body part that is further specified by number of sites treated and not by name or number of arteries. Separate body part values are used to specify the number of sites treated when the same procedure is performed on multiple sites in the coronary arteries. Examples: Angioplasty of two distinct sites in the left anterior descending coronary artery with placement of two stents is coded as Dilation of Coronary Arteries, Two Sites, with Intraluminal Device. Angioplasty of two distinct sites in the left anterior descending coronary artery, one with stent placed and one without, is coded separately as Dilation of Coronary Artery, One Site with Intraluminal Device, and Dilation of Coronary Artery, One Site with no device. 35

36 B4.4 Coronary arteries What s new for 2017??? The guideline for coronary arteries has been updated to allow for more specificity with the coding of coronary artery procedures. With the 2016 guidelines, and code set, there was not a qualifier value for the number of stents the patient had placed. For 2017, the code set provides values for multiple stent placement, up to 4 or more devices. 36

37 B4.4 Coronary arteries 2017 Guideline The coronary arteries are classified as a single body part that is further specified by number of arteries treated. One procedure code specifying multiple arteries is used when the same procedure is performed, including the same device and qualifier values. Examples: Angioplasty of two distinct coronary arteries with placement of two stents is coded as Dilation of Coronary Artery, Two Arteries with Two Intraluminal Devices. Angioplasty of two distinct coronary arteries, one with stent placed and one without, is coded separately as Dilation of Coronary Artery, One Artery with Intraluminal Device, and Dilation of Coronary Artery, One Artery with no device. 37

38 2017 ICD 10 PCS Updates Code Updates Copyright/Disclaimer 2014 AAPC text

39 So how do I learn 3,827 new procedure codes??? 39

40 Code Updates Most of the new ICD 10 PCS codes can be found in the Medical Surgical section, with the majority being added to the Heart and Great Vessels Body Systems. Other body systems from the Medical Surgical Section where updates occur are the Upper and Lower Arteries, Upper Veins, Lower Joints, and Anatomical Regions general and upper extremities. Additional character values have been added for each body system. Additions were also made to the Medical and Surgical related sections in the Administration Section, Extracorporeal Therapies and New Technology. 40

41 Heart and Great Vessels Root Operation - Bypass Body Part Character Additions P Pulmonary Trunk Q Pulmonary Artery, Left R Pulmonary Artery, Right W Thoracic Aorta, Descending X Thoracic Aorta, Ascending Arch Device Character Addition 8 Zooplastic Tissue Animal (non human) tissue Qualifier Character Additions A Innominate Artery B Subclavian D Carotid 41

42 Heart and Great Vessels Root Operation - Destruction Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending Arch 42

43 Heart and Great Vessels Root Operation - Dilation Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending Arch Device Character Addition 5 Intraluminal Device, Drug Eluting, Two 6 Intraluminal Device, Drug Eluting, Three 7 Intraluminal Device, Drug Eluting, Four of More E Intraluminal Device, Two F Intraluminal Device, Three G Intraluminal Device, Four or More 43

44 Heart and Great Vessels Root Operation - Excision Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 44

45 Heart and Great Vessels Root Operation - Extirpation Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 45

46 Heart and Great Vessels Root Operation - Insertion Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 46

47 Heart and Great Vessels Root Operation - Occlusion Body Part Character Additions H Pulmonary Valve 47

48 Heart and Great Vessels Root Operation - Release Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 48

49 Heart and Great Vessels Root Operation - Removal Device Character Additions N Intracardiac Pacemaker 49

50 Heart and Great Vessels Root Operation - Repair Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch F Aortic Valve G Mitral Valve J Tricuspid Valve Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Qualifier Character Additions J Truncal Valve E Atrioventricular valve, left G Atrioventricular valve, right 50

51 Heart and Great Vessels Root Operation - Replacement Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 51

52 Heart and Great Vessels Root Operation - Reposition Body Part Character Additions 0 Coronary Artery, One 1 Coronary Artery, Two Arteries W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch 52

53 Heart and Great Vessels Root Operation - Supplement Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch F Aortic Valve G Mitral Valve J Tricuspid Valve Device Character Additions 7 Autologous Tissue Substitute 8 Zooplastic Tissue J Synthetic Substitute K Nonautologous Tissue Substitute Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Qualifier Character Additions J Truncal Valve E Atrioventricular valve, left G Atrioventricular valve, right 53

54 Heart and Great Vessels Root Operation - Restriction Body Part Character Additions W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch Device Character Addition E Intraluminal Device, Branched or Fenestrated, One or Two Arteries F Intraluminal Device, Branched or Fenestrated, Three or more Arteries 54

55 Heart and Great Vessels Root Operation - Revision Device Character Additions N Intracardiac Pacemaker 55

56 Upper Arteries Root Operation - Dilation Device Character Addition 5 Intraluminal Device, Drug Eluting, Two 6 Intraluminal Device, Drug Eluting, Three 7 Intraluminal Device, Drug Eluting, Four of More E Intraluminal Device, Two F Intraluminal Device, Three G Intraluminal Device, Four or More 56

57 Upper Arteries Root Operation - Extirpation Qualifier Character Addition 6 Bifurcation 57

58 Lower Arteries Root Operation - Dilation Device Character Addition 5 Intraluminal Device, Drug Eluting, Two 6 Intraluminal Device, Drug Eluting, Three 7 Intraluminal Device, Drug Eluting, Four of More E Intraluminal Device, Two F Intraluminal Device, Three G Intraluminal Device, Four or More Qualifier Character Addition 6 Bifurcation 58

59 Lower Arteries Root Operation - Extirpation Qualifier Character Addition 6 Bifurcation 59

60 Upper Veins Root Operation - Insertion Device Character Addition 2 Monitoring Device M Neurostimulator Lead 60

61 Upper Veins Root Operation - Removal Body Part Character Addition 0 Azygos Vein 3 Innominate Vein, right 4 Innominate Vein, left Device Character Addition 2 Monitoring Device M Neurostimulator Lead Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic X External 61

62 Upper Veins Root Operation - Revision Body Part Character Addition 0 Azygos Vein 3 Innominate Vein, right 4 Innominate Vein, left Device Character Addition 2 Monitoring Device M Neurostimulator Lead Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic X External 62

63 Lower Joints Root Operation - Removal Body Part Character Addition A Hip Joint, Acetabular Surface, Right E Hip Joint, Acetabular Surface, Left R Hip Joint, Femoral Surface, Right S Hip Joint, Femoral Surface, Left T Knee Joint, Femoral Surface, Right U Knee Joint, Femoral Surface, Left V Knee Joint, Tibial Surface, Right W Knee Joint, Tibial Surface, Left C Knee Joint, Right D Knee Joint, Left Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic Device Character Addition J Synthetic Substitute Qualifier Character Addition C Patellar Surface 63

64 Lower Joints Root Operation - Replacement Device Character Addition L Synthetic Substitute, Unicondylar 64

65 Lower Joints Root Operation - Revision Body Part Character Addition A Hip Joint, Acetabular Surface, Right E Hip Joint, Acetabular Surface, Left R Hip Joint, Femoral Surface, Right S Hip Joint, Femoral Surface, Left T Knee Joint, Femoral Surface, Right U Knee Joint, Femoral Surface, Left V Knee Joint, Tibial Surface, Right W Knee Joint, Tibial Surface, Left C Knee Joint, Right D Knee Joint, Left Approach Character Addition 0 Open 3 Percutaneous 4 Percutaneous Endoscopic X External Device Character Addition J Synthetic Substitute Qualifier Character Addition C Patellar Surface 65

66 Anatomical Regions, General Root Operation - Transplantation Addition of new codes for a Face Transplantation Procedure Transplantation is defined as putting in or on all or a portion of a living body part taken from another individual or animal to physically take the pace and/or function of all or a portion of a similar body part. 0WY20Z0 Face transplantation, Allogenic Donor, Open Approach Allogenic Donor from another person genetically different - siblings 0WY20Z1 Face transplantation, Syngeneic Donor, Open Approach Syngeneic Donor from another person genetically identical - Twins 66

67 Anatomical Regions, Upper Extremities Root Operation - Transplantation Addition of new codes for a Hand Transplantation Procedure Transplantation is defined as putting in or on all or a portion of a living body part taken from another individual or animal to physically take the pace and/or function of all or a portion of a similar body part. 0XYJ0Z0 Hand transplantation, Allogenic Donor, Right Hand, Open Approach 0XYK0Z1 Hand transplantation, Syngeneic Donor, Left Hand, Open Approach 67

68 Administration Section Physiological Systems and Anatomical Regions Root Operation - Introduction Approach Character Addition 0 Open 68

69 New Technology Cardiovascular System Root Operation - Assistance Assistance is taking over a portion of a physiological function by extracorporeal means X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2 Section(X) New Technology Body System(2) Cardiovascular System Operation(A) Assistance Body Part(5) Innominate Artery and Left Common Carotid Artery Approach(3) Percutaneous Device /Substance /Technology(1) Cerebral Embolic Filtration, Dual Filter Qualifier(2) New Technology Group 2 69

70 New Technology Cardiovascular System Root Operation - Replacement Section X New Technology Body System 2 Cardiovascular System Operation R Replacement Body Part Approach Device/Substance/ Technology F Aortic Valve 0 Open 3 Percutaneous 4 Percutaneous Endoscopic 3 Zooplastic Tissue, Rapid Deployment Technique Qualifier 2 New Technology Group 2 70

71 New Technology Skin, Subcutaneous Tissue, Fascia and Breast Root Operation - Replacement Section X New Technology Body System H Skin, Subcutaneous Tissue, Fascia and Breast Operation R Replacement Body Part Approach Device/Substance/ Technology P Skin X External L Skin Substitute, Porcine Liver Derived Qualifier 2 New Technology Group 2 71

72 New Technology Bones Root Operation - Reposition Section X New Technology Body System N Bones Operation S Reposition Body Part Approach Device/Substance/ Technology 0 Lumbar Vertebra 3 Cervical Vertebra 4 Thoracic Vertebra 0 Open 4 Percutaneous Endoscopic 3 Magnetically Controlled Growth Rod Qualifier 2 New Technology Group 2 72

73 New Technology Joints Root Operation - Fusion Section X New Technology Body System R Joints Operation G Fusion Body Part Approach Device/Substance/ Technology 0 Occipital-cervical Joint 1 Cervical Vertebral Joint 2 Cervical Vertebral Joints, 2 or more 4 Cervicothoracic Vertebral Joint 6 Thoracic Vertebral Joint 7 Thoracic Vertebral Joints, 2 to 7 8 Thoracic Vertebral Joints, 8 or more A Thoracolumbar Vertebral Joint B Lumbar Vertebral Joint C Lumbar Vertebral Joints, 2 or more D Lumbosacral Joint 0 Open 9 Interbody Fusion Device, Nanotextrured Surface Qualifier 2 New Technology Group 2 73

74 New Technology Anatomical Regions Root Operation - Introduction Section X New Technology Body System W Anatomical Regions Operation 0 Introduction Body Part Approach Device/Substance/ Technology 3 Peripheral Vein 3 Percutaneous 7 Andexanet Alfa, Factor Xa Inhibitor Reversal Agent 9 Defibrotide Sodium Anticoagulant 4 Central Vein 3 Percutaneous 7 Andexanet Alfa, Factor Xa Inhibitor Reversal Agent 9 Defibrotide Sodium Anticoagulant Qualifier 2 New Technology Group 2 2 New Technology Group 2 D Mouth and Pharynx X External 8 Uridine Triacetate 2 New Technology Group 2 74

75 Questions? 75

76 References: Centers for Medicare and Medicaid Services FY 2017 IPPS Final Rule Homepage Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html 76