FY 2018 Updates Part 2: ICD-10-PCS Codes and Official Guidelines for Coding and Reporting

Transcription

1 FY 2018 Updates Part 2: ICD-10-PCS Codes and Official Guidelines for Coding and Reporting AHA Central Office Faculty: Nelly Leon-Chisen, RHIA, Director, Coding and Classification Anita Rapier, RHIT, CCS Managing Editor, Senior Coding Consultant Housekeeping Items Download Slides and CEU Information Ask Question 2 1

2 Objectives Learn about: FY 2018 Updates to the ICD-10-PCS codes and ICD-10- PCS Official Guidelines for Coding and Reporting. Learn about: Highlights of key code changes, such as Extraction procedures brush biopsies and nonexcisional debridements Temporary external heart assist systems Revisions of body part values Addition of approach values Changes to device values Changes to qualifier values 3 Summary of PCS Code Changes New PCS codes: 3,562 Revised codes: 1,821 Deleted codes: 646 mostly to simplify certain body part values or to correct clinical discrepancies 4 2

3 Radiotherapeutic Brain Implant New device value to identify a new type of radioactive implant placed in the brain to treat primary malignant tumors and brain metastases Table 00H, Central Nervous System and Cranial Nerves, Insertion 5 Resuscitative Endovascular Balloon Occlusion of the Aorta New values to identify resuscitative endovascular balloon occlusion of the aorta Table 02L, Heart and Great Vessels, Occlusion Table 04L, Lower Arteries, Occlusion 6 3

4 Correction of Congenital Heart Defects Correction of left ventricular outflow tract obstruction Body part value added in table 027, Heart and Great Vessels, Dilation L Ventricle, Left 7 Correction of Congenital Heart Defects Ligation of pulmonary trunk or pulmonary artery 2 body parts added in table 02L, Heart and Great Vessels, Occlusion P Pulmonary Trunk Q Pulmonary Artery, Right 8 4

5 Correction of Congenital Heart Defects Release of myocardial bridge 4 body parts added in table 02N, Heart and Great Vessels, Release 9 Correction of Congenital Heart Defects Alfieri stitch procedure Body part added in table 02V, Heart and Great Vessels, Restriction G Mitral Valve 10 5

6 Correction of Congenital Heart Defects Fontan completion procedure 3 qualifiers added in table 061, Lower Veins, Bypass 11 Oxidized Zirconium on Polyethylene Bearing Surface New device value in table 0SR, Lower Joints, Replacement to identify hybrid type of bearing surface for hip replacements and knee replacements Example: 0SRB06Z, Replacement of left hip joint with oxidized zirconium on polyethylene synthetic substitute, open approach 12 6

7 Central Nervous System From: Central Nervous System To: Central Nervous System and Cranial Nerves 13 Procedures on Cerebral Ventricle Root operation Dilation has been added to Central Nervous System and Cranial Nerves body system for cerebral ventricle body part Allows capture of dilation of a ventricular stricture 14 7

8 Procedures on Cerebral Ventricle New approach and device values have been added in table 001, Bypass, Central Nervous System and Cranial Nerves, for body part Cerebral Ventricle 15 Graft Replacement Root operation Replacement has been added to these body systems: Table 00R 01R 0BR 0KR 0MR Body System 0 Central Nervous and Cranial Nerves 1 Peripheral Nervous B Respiratory K Muscles M Bursae and Ligaments 16 8

9 Insertion of External Heart Assist Devices Title for device External Heart Assist System has been changed to Short-term External Heart Assist System at the following tables 02H Insertion Heart and Great Vessels 02P Removal Heart and Great Vessels 02W Revision Heart and Great Vessels New qualifier has been created for intraoperative use at table 02H, Insertion Heart and Great Vessels 17 General Device Guidelines 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. 18 9

10 Insertion of External Heart Assist Devices New qualifier Biventricular has been added to tables 02P and 02W, Removal and Revision in the Heart and Great Vessels body system, for Shortterm External Heart Assist System, 19 Extraction Procedures Root operation Extraction has been added to these body systems: Table 0DD 0KD 0LD 0ND 0PD 0QD Body System D Gastrointestinal K Muscles L Tendons N Head and Facial Bones P Upper Bones Q Lower Bones 20 10

11 Extraction Procedures -Examples Endoscopic brush biopsy of stomach 0DD68ZX, Extraction of stomach, via natural or artificial opening endoscopic, diagnostic, for the endoscopic brush biopsy of the stomach Debridement of the right lower leg including removal of necrotic -muscle using jet lavage 0KDS0ZZ, Extraction of right lower leg muscle, open approach When multiple layers of the same site are debrided, assign only a code for the deepest layer of debridement. In this instance, only debridement of the muscle as the deepest layer is assigned. 21 Extraction Procedures - Lymphatic Two new rows were added to table 07D, Lymphatic and Hemic Systems, Extraction Resulting in 61 new codes 22 11

12 Extraction Procedures Lymphatic (cont.) 23 Extraction Procedures - Respiratory One new row was added to table 0BD, Respiratory System, Extraction Resulting in 38 new codes 24 12

13 Drug-Coated Balloon Dilation of Lower Arteries Qualifier for Drug-Coated Balloon has been added to additional body parts in table 047, Lower Arteries, Dilation 25 Drug-Coated Balloon Dilation of Lower Arteries (cont.) The body part values added to the row on table 047 are shown below: 0 Abdominal Aorta 9 Renal Artery, Right P Anterior Tibial Artery, Right 1 Celiac Artery A Renal Artery, Left Q Anterior Tibial Artery, Left 2 Gastric Artery B Inferior Mesenteric Artery R Posterior Tibial Artery, Right 3 Hepatic Artery C Common Iliac Artery, Right S Posterior Tibial Artery, Left 4 Splenic Artery D Common Iliac Artery, Left T Peroneal Artery, Right 5 Superior Mesenteric Artery E Internal Iliac Artery, Right U Peroneal Artery, Left 6 Colic Artery, Right F Internal Iliac Artery, Left V Foot Artery, Right 7 Colic Artery, Left H External Iliac Artery, Right W Foot Artery, Left 8 Colic Artery, Middle J External Iliac Artery, Left Y Lower Artery 26 13

14 Hepatic Artery Bypass Hepatic Artery body part added to table 041, Lower Arteries, Bypass, for Renal Artery qualifier values 27 Procedures Involving Hepatic Duct Common Hepatic Duct body part added to all root operation tables in Hepatobiliary and Pancreas body system containing body part values for Left and Right Hepatic Duct This change affects 16 tables

15 Extirpation of Spinal Canal Spinal Canal body part added to table 00C, Central Nervous System and Cranial Nerves, Extirpation Table Body System Root Operation 00C 0 Central Nervous and Cranial C Extirpation Nerves U Spinal Canal Example: Open surgical evacuation of solid hematoma in the epidural space at the level of the lumbar spine 00CU0ZZ Extirpation of matter from spinal canal, open approach 29 Lower Artery Bypass Body part values added to table 041, Lower Arteries, Bypass T Peroneal Artery, Right U Peroneal Artery, Left V Foot Artery, Right W Foot Artery, Left Qualifier values added in table 041 Qualifier P Foot Artery Q Lower Extremity Artery S Lower Extremity Vein 30 15

16 Intestinal Repositioning Small Intestine and Large Intestine body parts have been added to table 0DS, Gastrointestinal System, Reposition 8 Small Intestine E Large Intestine 31 Procedures on Thyroid Gland Thyroid Gland Isthmus body part added to tables 0GB, Endocrine System, Excision, and 0GD, Endocrine System, Resection 32 16

17 Streamlined s Body parts have been streamlined to remove distinctions in the following areas From R Diaphragm, Right S Diaphragm, Left To T Diaphragm From P Greater Saphenous Vein, Right Q Greater Saphenous Vein, Left R Lesser Saphenous Vein, Left S Lesser Saphenous Vein, Right To P Saphenous Vein, Right Q Saphenous Vein, Left 33 Streamlined s (cont.) From S Greater Omentum U Omentum T Lesser Omentum From To 1 Frontal Bone, Right 1 Frontal Bone 2 Frontal Bone, Left 7 Occipital Bone 7 Occipital Bone, Right C Sphenoid Bone 8 Occipital Bone, Left R Maxilla C Sphenoid Bone, Right D Sphenoid Bone, Left R Maxilla, Right S Maxilla, Left To 34 17

18 Titles Revised Titles have been revised to clarify intended use: From To 3 Epidural Space 3 Epidural Space, Intracranial 4 Subdural Space 4 Subdural Space, Intracranial 5 Subarachnoid Space 5 Subarachnoid Space, Intracranial K Nose From To K Nasal Mucosa and Soft Tissue From A Skin, Genitalia A Skin, Inguinal To 35 Titles Revised (cont.) From 4 Subcutaneous Tissue and Fascia, Anterior Neck 5 Subcutaneous Tissue and Fascia, Posterior Neck From C Trunk Bursa and Ligament, Right D Trunk Bursa and Ligament, Left F Thorax Bursa and Ligament, Right G Thorax Bursa and Ligament, Left To 4 Subcutaneous Tissue and Fascia, Right Neck 5 Subcutaneous Tissue and Fascia, Left Neck To C Upper Spine Bursa and Ligament D Lower Spine Bursa and Ligament F Sternum Bursa and Ligament G Rib(s) Bursa and Ligament 36 18

19 Titles Revised (cont.) From To 1 Rib, Right 1 Ribs, 1 to 2 2 Rib, Left 2 Ribs, 3 or More 37 Titles Revised (cont.) Titles have been revised to be consistent with common usage: From S Metacarpocarpal Joint, Right T Metacarpocarpal Joint, Left To S Carpometacarpal Joint, Right T Carpometacarpal Joint, Left From K Metatarsal-Tarsal Joint, Right L Metatarsal-Tarsal Joint, Left To K Tarsometatarsal Joint, Right L Tarsometatarsal Joint, Left 38 19

20 Values Added J Thyroid Gland Isthmus added to tables 0GB Excision Endocrine System 0GT Resection Endocrine System 3 Oral Cavity and Throat added to tables 0WB Excision Anatomical Regions, General 0WQ Repair Anatomical Regions, General H Retroperitoneum added to table 0WC Extirpation of the Anatomical Regions, General 39 Approach Values Added Percutaneous ( 3 ) approach value added to some tables For Tricuspid Valve body part in table 02R, Heart and Great Vessels, Replacement For all heart valve body part in table 02W, Heart and Great Vessels, Revision For body part value Atrium, Right, with qualifier Atrium, Left in table 021, Heart and Great Vessels, Bypass 40 20

21 Approach Values Added (cont.) Via Natural or Artificial Opening ( 7 ) value added to some tables Uterus and Vagina For example, bimanual reposition of uterus 41 Approach Values Added (cont.) Via Natural or Artificial Opening Endoscopic ( 8 ) approach added to several tables for: Lymphatic and Hemic Systems Ear, Nose, Sinus Respiratory System Hepatobiliary System and Pancreas Female Reproductive System Male Reproductive System 42 21

22 Approach Values Added (cont.) Via Natural or Artificial Opening ( 7 ) and Via Natural or Artificial Opening Endoscopic ( 8 ) approach added to a some tables Lower Veins Example: Transorifice esophageal vein banding Ear, Nose, Sinus Example: Myringotomy to drain the middle ear 43 Approach Values Added (cont.) Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance ( F ) added to 0DB 0DT Excision, Gastrointestinal System Resection, Gastrointestinal System Example: Laparoscopic-assisted intestinal pullthrough procedures 44 22

23 Device Values Changes Device values added to some tables Synthetic Substitute and Nonautologous Tissue Substitute added for all applicable body part values in tables 00U, Central Nervous System, Supplement and 01U, Peripheral Nervous System, Supplement Y Other Device added to Insertion Removal Revisions 45 Device Values Changes Titles of some device values revised From Device W Vascular Access Device, Reservoir X Vascular Access Device To Device W Vascular Access Device, Totally Implantable X Vascular Access Device, Tunneled Example: 0JH60WZ, Insertion of totally implantable vascular access device into chest subcutaneous tissue and fascia, open approach 46 23

24 Device Values Changes (cont.) Titles of some device values revised (cont.) From Device R External Heart Assist System To Device R Short-term External Heart Assist System 47 Qualifier Values Changes Qualifier values added to some tables Extracranial Artery, Right added for body part values of Left Common Carotid Artery, Left Internal Carotid Artery, and Left External Carotid Artery Extracranial Artery, Left added for body part values of Right Common Carotid Artery, Right Internal Carotid Artery, and Right External Carotid Artery Axillary Artery and Brachial Artery for the body part value Thoracic Aorta in table 021, Heart and Great Vessels, Bypass 48 24

25 Qualifier Values Changes (cont.) Qualifier values added to some tables (con t) Hepatic Vein added for Portal Vein body part value in table 061, Lower Veins, Bypass 49 Qualifier Values Changes (cont.) Qualifier values added to some tables (con t) Types of flaps added for Trunk Muscle body part values in table 0KX, Muscles, Transfer F Trunk Muscle, Right G Trunk Muscle, Left Qualifier 5 Latissimus Dorsi Myocutaneous Flap 7 Deep Inferior Epigastric Artery Perforator Flap 8 Superficial Inferior Epigastric Artery Flap 9 Gluteal Artery Perforator Flap 50 25

26 Qualifier Values Changes (cont.) Supracervical added for Uterus body part value in table 0UT, Female Reproductive System, Resection A supracervical hysterectomy refers to removal of only the uterus with the cervix being left in place. Whereas a total hysterectomy involves the removal of both the cervix and the uterus. 0UT97ZL, Resection of uterus, via natural or artificial opening, supracervical 51 Total Hysterectomy Only one ICD-10-PCS code describing resection of the uterus is required for a total hysterectomy. 0UT90ZZ, Resection of uterus, open approach. The Alphabetic Index has been revised as follows: Hysterectomy total see Resection, Uterus 0UT

27 Other ICD-10-PCS Changes Hemodialysis and Renal Replacement Therapy Three new duration values added to table 5A1, Physiological Systems, Performance, to capture duration and continuity of hemodialysis procedures Duration D Urinary 7 Intermittent, Less than 6 Hours Per Day 8 Prolonged Intermittent, 6-18 Hours Per Day 9 Continuous, Greater than 18 Hours Per Day 53 Obstetrics Section New Qualifier A new qualifier value has been created to capture the manual removal of retained placenta. The change affects table 10D, Extraction Pregnancy Qualifier 1 Products of Conception, Retained 9 Manual 54 27

28 Section X New Technology Table XK0, Muscles, Tendons, Bursae and Ligaments, Introduction, added for new technique for treating advanced, limb-threatening peripheral artery disease 55 Section X New Technology (cont.) Table XY0, Extracorporeal, Introduction, added for intraoperative treatment of vein grafts during coronary artery bypass or peripheral artery bypass 56 28

29 Section X New Technology (cont.) Device value added to table XRG, Joints, Fusion, to capture use of radiolucent porous interbody fusion devices (IFD) during spinal fusion Device/Substance/Technology F Interbody Fusion Device, Radiolucent Porous 57 Section X New Technology (cont.) Four Substance values were added to table XW0, Anatomical Regions, Introduction Device/Substance/Technology A Bezlotoxumab Monoclonal Antibody B Cytarine and Daunorubicin Liposome Antineoplastic C Engineered Autologous Chimeric Antigen Receptor T-Cell Immunotherapy F Other New Technology Therapeutic Substance 58 29

30 Format of Guideline Changes Narrative changes appear in bold text (e.g. a more definitive root operation) Items underlined have been moved within the guidelines since October 1, 2017 (e.g. control of acute bleeding) Deletions are shown as strikeouts (any of the definitive root operations) The complete guidelines may be downloaded by visiting ICD-10-PCS-and-GEMs.html. 59 Discontinued or Incomplete Procedure Guideline B3.3 If the intended procedure is discontinued or otherwise not completed, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation Inspection of the body part or anatomical region inspected

31 Control vs. More Definitive Root Operations Guideline B3.7 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 a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then the more definitive root operation is coded instead of Control. 61 Guideline B4.1c If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the furthest anatomical site from the point of entry. Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part

32 Audience Questions 63 Additional Questions Review upcoming 4 th Quarter Coding Clinic issue for more details and examples 64 32

33 Please fill out evaluation at: CEU Certificate will be available upon completion

34 September 2017 Registrant name: Title: Organization: Address: City, State, ZIP: This serves as verification for your Continuing Education for the AHA Coding Clinic s webinar FY 2018 Updates Part 2: ICD-10-PCS Codes and Official Guidelines for Coding and Reporting by Nelly Leon-Chisen, RHIA, Director of Coding and Classification, AHA and Anita Rapier, RHIT, CCS, Managing Editor, Senior Coding Consultant, AHA. The webinar was held on September 20, 2017 (and available for on-demand viewing after the live date) and was one hour in length. Retain this verification in your personal file for audit purposes. Thank you for your interest and participation. Chabre Ross Program Chairperson American Hospital Association

35 AHA Central Office Certificate of Approval Name FY 2018 Updates Part 2: ICD-10-PCS Codes and Official Guidelines for Coding and Reporting (Live or On-Demand) Index # AHA A This Index # is valid for education purchased prior to 7/31/2018 Date *This program has the prior approval of AAPC for continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. This program meets AAPC guidelines for 1.0 CEUs. On Demand product requires successful completion of a Post- Test for Core A and all specialties except CIRCC, CCPC, CEMC, CFPC, CIMC, CPEDC and CRHC for continuing education units.

36 NELLY LEON-CHISEN, RHIA Director, Coding and Classification American Hospital Association Nelly Leon-Chisen, RHIA, is the Director of Coding and Classification at the American Hospital Association where she is responsible for leading the AHA Central Office on ICD-10-CM and ICD-10-PCS and Central Office on HCPCS. The AHA Central Office, in cooperation with the Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), the Centers for Medicare and Medicaid Services (CMS) and the American Health Information Management Association (AHIMA), serves as the authoritative source on ICD-10-CM and ICD-10-PCS relative to health care payment systems, statistical reporting, and health services research. She represents the AHA as one of the four ICD-10 Cooperating Parties. She is also the executive editor of AHA Coding Clinic for ICD-10-CM and ICD-10-PCS and AHA Coding Clinic for HCPCS, and author of ICD-10-CM and ICD-10-PCS Coding Handbook published by AHA Press. She has represented the AHA on other national groups such as the CPT-5 Project Advisory Group, Medicare Technical Advisory Group Outpatient Workgroup, ICD-10-PCS Technical Advisory Group, Panel to Evaluate the U.S. Standard Certificates, HEDIS Coding Users Panel, and ICD-10 Coordination and Maintenance Committee. She was co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Implementation Workgroup. She also serves as staff to the AHA representative to the CPT Editorial Panel. She co-chaired the joint AHA-AHIMA ICD-10-CM Field Testing Project and was the technical lead for the AHA-AHIMA Facility Evaluation and Management (E/M) Code Development Expert Panel. She has over 30 years experience in the health information management field including consulting, teaching, technical and management experience in hospital medical record departments. She is a Past President of the Chicago Area Health Information Management Association and a recipient of the Professional Achievement Award from the Illinois Health Information Management Association. She has lectured extensively on coding, DRG and data quality issues throughout the United States and internationally. She has also testified on behalf of the American Hospital Association at numerous National Committee on Vital and Health Statistics hearings on ICD-10-CM and ICD-10-PCS. She is a Registered Health Information Administrator and holds a B.S. in Medical Record Administration from the University of Illinois at Chicago, and a B.A. in History and English from Northeastern Illinois University in Chicago.

37 Anita Rapier, RHIT, CCS is a Senior Coding Consultant with the American Hospital Association s (AHA) Central Office on ICD-10-CM and ICD-10-PCS. The AHA Central Office serves as the official U.S. Clearinghouse on medical coding for the proper use of the ICD-10-CM/ICD-10-PCS systems and Level I HCPCS (CPT-4 codes) for hospital providers and certain Level II HCPCS codes for hospitals, physicians and other health professionals. ANITA RAPIER, RHIT, CCS Senior Coding Consultant American Hospital Association She is also the managing editor of AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, and is responsible for developing educational material for Coding Clinic. She is part of the team responsible for the annual revisions to the ICD-10-CM and ICD-10-PCS Coding Handbook published by AHA Press. Ms. Rapier has over 25 years of experience in Health Information Management (HIM). She has held several positions in HIM, involving coding education, quality and compliance, hospital-based outpatient, acute care and long term care settings. Ms. Rapier has presented numerous educational seminars and authored articles on coding and compliance. She has been an independent health information management consultant specializing in hospital and physician coding, quality assessment, and compliance. She is a featured speaker for the popular AHA Coding Clinic webinar series and an AHIMA-Approved ICD-10 Trainer.