Inpatient ICD-9-CM Mapping to ICD-10 PCS Procedures Involving the Application of Integra Bilayer Wound Matrix Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th Revision (ICD-10) Procedure Coding System (PCS) in place of the 9 th Revision (ICD-9) procedure codes. CMS has provided a General Equivalence Mappings (GEMS) that crosswalk ICD-9 procedure codes to ICD-10 PCS (available at https://www.cms.gov//coding/icd10/2016-icd-10-pcs-and-gems.html). Below, Integra LifeSciences Corporation provides the mappings for select ICD-9 procedure codes. While Integra LifeSciences Corporation has used reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. It is always the Provider s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Integra LifeSciences Corporation assumes no responsibilities or liabilities for the timeliness, accuracy, and completeness of the information contained herein. Since reimbursement laws, regulations, and payor policies change frequently, it is recommended that providers consult with their payors, coding specialists, and/or legal counsel regarding coverage, coding and payment issues. ICD-9 Procedure Code 86.67 Dermal regenerative graft ICD-10 ICD-10 PCS Code Root Operation PCS Replacement (0HR) Code 0HR0XK3 Replacement of Scalp Skin with Nonautologous Tissue Substitute, Full 0HR0XK4 Replacement of Scalp Skin with Nonautologous Tissue Substitute, Partial 0HR1XK3 Replacement of Face Skin with Nonautologous Tissue Substitute, Full Thickness, 0HR1XK4 Replacement of Face Skin with Nonautologous Tissue Substitute, Partial 0HR4XK3 Replacement of Neck Skin with Nonautologous Tissue Substitute, Full Thickness, 0HR4XK4 Replacement of Neck Skin with Nonautologous Tissue Substitute, Partial 0HR5XK3 Replacement of Chest Skin with Nonautologous Tissue Substitute, Full 0HR5XK4 Replacement of Chest Skin with Nonautologous Tissue Substitute, Partial 0HR6XK3 Replacement of Back Skin with Nonautologous Tissue Substitute, Full Thickness, 0HR6XK4 Replacement of Back Skin with Nonautologous Tissue Substitute, Partial 0HR7XK3 Replacement of Abdomen Skin with Nonautologous Tissue Substitute, Full 0HR7XK4 Replacement of Abdomen Skin with Nonautologous Tissue Substitute, Partial 0HR8XK3 Replacement of Buttock Skin with Nonautologous Tissue Substitute, Full 0HR8XK4 Replacement of Buttock Skin with Nonautologous Tissue Substitute, Partial Potential MS-DRG Assignment 622-624,
ICD-9 Procedure Code 86.67 Dermal regenerative graft ICD-10 ICD-10 PCS Code Root Operation PCS Replacement (0HR) Code 0HR9XK3 Replacement of Perineum Skin with Nonautologous Tissue Substitute, Full 0HR9XK4 Replacement of Perineum Skin with Nonautologous Tissue Substitute, Partial 0HRAXK4 Replacement of Genitalia Skin with Nonautologous Tissue Substitute, Partial 0HRBXK3 Replacement of Right Upper Arm Skin with Nonautologous Tissue Substitute, Full 0HRBXK4 Replacement of Right Upper Arm Skin with Nonautologous Tissue Substitute, Partial 0HRCXK3 Replacement of Left Upper Arm Skin with Nonautologous Tissue Substitute, Full 0HRCXK4 Replacement of Left Upper Arm Skin with Nonautologous Tissue Substitute, Partial 0HRDXK3 Replacement of Right Lower Arm Skin with Nonautologous Tissue Substitute, Full 0HRDXK4 Replacement of Right Lower Arm Skin with Nonautologous Tissue Substitute, Partial 0HREXK3 Replacement of Left Lower Arm Skin with Nonautologous Tissue Substitute, Full 0HREXK4 Replacement of Left Lower Arm Skin with Nonautologous Tissue Substitute, Partial 0HRFXK3 Replacement of Right Hand Skin with Nonautologous Tissue Substitute, Full 0HRFXK4 Replacement of Right Hand Skin with Nonautologous Tissue Substitute, Partial 0HRGXK3 Replacement of Left Hand Skin with Nonautologous Tissue Substitute, Full 0HRGXK4 Replacement of Left Hand Skin with Nonautologous Tissue Substitute, Partial 0HRHXK3 Replacement of Right Upper Leg Skin with Nonautologous Tissue Substitute, Full 0HRHXK4 Replacement of Right Upper Leg Skin with Nonautologous Tissue Substitute, Partial 0HRJXK3 Replacement of Left Upper Leg Skin with Nonautologous Tissue Substitute, Full 0HRJXK4 Replacement of Left Upper Leg Skin with Nonautologous Tissue Substitute, Partial 0HRKXK3 Replacement of Right Lower Leg Skin with Nonautologous Tissue Substitute, Full 0HRKXK4 Replacement of Right Lower Leg Skin with Nonautologous Tissue Substitute, Partial 0HRLXK3 Replacement of Left Lower Leg Skin with Nonautologous Tissue Substitute, Full 0HRLXK4 Replacement of Left Lower Leg Skin with Nonautologous Tissue Substitute, Partial 0HRMXK3 Replacement of Right Foot Skin with Nonautologous Tissue Substitute, Full 0HRMXK4 Replacement of Right Foot Skin with Nonautologous Tissue Substitute, Partial 0HRNXK3 Replacement of Left Foot Skin with Nonautologous Tissue Substitute, Full 0HRNXK4 Replacement of Left Foot Skin with Nonautologous Tissue Substitute, Partial Potential MS-DRG Assignment 746-747, 774, 907-909,, 987-989 513-514,
040 Peripheral/Cranial Nerve and Other Nervous System Procedures with MCC 041 Peripheral/Cranial Nerve and Other Nervous System Procedures with CC or Peripheral Neurostimulator 1 1 $22,134.50 $12,653.23 042 Peripheral/Cranial Nerve and Other Nervous System Procedures without 1 $11,320.99 133 Other Ear, Nose, Mouth and Throat O.R. Procedures with 134 Other Ear, Nose, Mouth and Throat O.R. Procedures without 3 Ear, Nose, Mouth and Throat 3 Ear, Nose, Mouth and Throat 264 Other Circulatory System O.R. Procedures 5 Circulatory System 463 Wound Debridement and Skin Graft Except Disorders with MCC 464 Wound Debridement and Skin Graft Except Disorders with CC 465 Wound Debridement and Skin Graft Except Disorders without 513 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with $11,418.20 $6,270.56 $17,614.21 $32,090.46 $18,183.72 $12,187.48 $8,949.93
514 Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without 573 Skin Graft for Skin Ulcer or Cellulitis with MCC Skin, 574 Skin Graft for Skin Ulcer or Cellulitis with CC Skin, 575 Skin Graft for Skin Ulcer or Cellulitis without 576 Skin Graft Except for Skin Ulcer or Cellulitis with MCC 577 Skin Graft Except for Skin Ulcer or Cellulitis with CC 578 Skin Graft Except for Skin Ulcer or Cellulitis without 622 Skin Grafts and Wound Debridement for Endocrine, Nutritional Disorders with MCC 623 Skin Grafts and Wound Debridement for Endocrine, Nutritional Disorders with CC 624 Skin Grafts and Wound Debridement for Endocrine, Nutritional Disorders without Skin, Skin, Skin, Skin, Disorders Disorders Disorders $5,795.87 $21,988.40 $17,036.95 $8,821.12 $25,760.27 $13,649.72 $8,249.23 $21,952.62 $11,300.72 $6,394.00
746 Vagina, Cervix and Vulva Procedures with 747 Vagina, Cervix and Vulva Procedures without 774 Vaginal Delivery with Complicating Diagnoses 13 Female Reproductive System - 13 Female Reproductive System - 14 Pregnancy, Childbirth and the Puerperium - Medical 904 Skin Grafts for Injuries with 21 Injuries, Poisonings and Toxic Effects of Drugs $8,796.07 $5,584.07 $4,748.09 $19,455.72 905 Skin Grafts for Injuries without 21 Injuries, Poisonings $8,228.35 and Toxic Effects of Drugs 927 Extensive Burns or Full Thickness Burns with 22 Burns - $86,167.53 Mechanical Ventilation > 96 Hours with Skin Graft 928 Full Thickness Burns with Skin Graft or 22 Burns - $30,978.28 Inhalation Injury with 929 Full Thickness Burns with Skin Graft or 22 Burns - $15,258.65 Inhalation Injury without 957 Other O.R. Procedures for Multiple 24 Multiple Significant $41,098.24 Significant Trauma with MCC 958 Other O.R. Procedures for Multiple Significant Trauma with CC Trauma - 24 Multiple Significant Trauma - $23,013.51 959 Other O.R. Procedures for Multiple Significant Trauma without MCC Acronym Key: MS-DRG Medical Severity Diagnosis Related Groups MDC Major Diagnostic Category CC Comorbidities and Complications MCC Major Comorbidities and Complications 24 Multiple Significant Trauma - $15,072.59 Reference: The ICD-10-PCS codes and descriptors, and DRG payment groups are effective October 1, 2016. *The average payment rates provided are a benchmark reference only. There is no official publication of the average hospital rate; therefore the national average payments provided in the table above are approximate. Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation in the United States and/or other countries. 2016 Integra LifeSciences Corporation. All rights reserved. 0536451 1 (2016-09)