ICD-10-PCS FY2021 CODING UPDATE OVERVIEW
Post written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10- CM/PCS Trainer.
For FY2021 we will see 544 new ICD-10-PCS codes, but no revisions or deletions. The Centers for Medicare and Medicaid Services (CMS) has published detailed information and PCS tables on the following website: https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs
In order to identify that a radioactive element was left in place after Brachytherapy, new code additions were made to several “Insertion” tables under the column for “device” with a designation of “1” for Radioactive element; 00H, 01H, 07H, 09H, 0CH, 0DH, 0FH, 0GH, 0TH, 0UH, and 0VH. This expanded the number of new codes greatly to capture the different body part. The following is the 00H table for FY2021:
The PCS operation of “Fragmentation” has been expanded for FY2021 with several new codes. In PCS, fragmentation has the meaning of Breaking solid matter in a body part into pieces. Typically, we think of a Lithotripsy in the urinary tract, but now this fragmentation can be performed on clots and plaque as well. The ultrasonic Qualifier “0” would be selected for this device treatment. Look at the medical record documentation closely as it may mention “EkoSonic®”, which is the Endovascular System that provides the fragmentation technique. The EkoSonic catheter is comprised of two parts: The Infusion catheter and the ultrasonic core. The following is one Fragmentation table 02F showing the addition of the body part for Pulmonary Trunk, Artery and Vein:
There are times when pancreatic cancer will block the bile duct or duodenum, then bypass surgery may be another way to treat the symptoms of jaundice. Thus, we have a new table/code for a pancreatic duct and/or pancreas bypass procedure within table 0F1.
Fusion tables 0RG and 0SG have added a new device value. This will allow for coded data of joint fusion procedures that use a sustained compression internal fixation device to be captured. MedShape, Inc. is a shape memory orthopedic device company headquartered in Atlanta, Georgia that has developed a device made of Nitinol, which is a nickel and titanium alloy technology. This specific device (metal) will bend, stretch, and recover its shape.
Extraction table 10D with body part “Products of Conception, Ectopic” was missing two approaches so now the approach choices; Open and percutaneous endoscopic, were added. This will be helpful for procedures on Ectopic Pregnancies.
Measurement table 4A0 has added additional qualifiers to capture portal venous pressure and musculoskeletal compartment measurements for the Arterial, Venous and Musculoskeletal body systems. When measuring the portal venous pressure this can aide in diagnosing “Chronic Liver Disease. In addition, when measuring intracranial arterial flow this can assist with identifying large vessel occlusions in acute stroke patients. Another measurement in table 4A0 which is new, is for the musculoskeletal body system, with qualifier E, Compartment. This PCS code will be assigned when the measurement of muscle compartment pressure is used to diagnose compartment syndrome following an injury. If the pressure is too high, a fasciotomy often is performed to release the muscles in the compartment.
Table BF5 Other Imaging has added a new qualifier for the capture if Spy Agent™ Green (Indocyanine Green Dye – ICG) which is used intraoperatively along with a cholangiogram to avoid bile duct injuries in laparoscopic cholecystectomies. Indocyanine Green Dye PCS qualifier if “0”.
Also, in table BF5 Other Imaging is the Qualifier (1) for Bacterial Autofluorescence which is used for wound imaging. The process is called MolecuLight i:X® which is technology that will indicate is there is an Infective organism present in and around the wound. It will show up red or cyan due to the autofluorescence of the infection and normal tissue is shades of green. Suggest you speak to your Wound Care Department Director about this to ensure it is coded correctly on inpatients. Also, check out the two CPT Category III codes for this wound care service: 0598T and 0599T.
Radiation Therapy has several new codes for a specific Brachytherapy isotope. The common isotope used in brachytherapy, Cesium 131, was added resulting in 64 new PCS codes.
In Section X, for New Technology character 6 were added for the device/substance/technology. Here is a list of the character 6 additions for FY2021:
The last PCS value on this list above is in Supplement Table XNU where the addition of “Synthetic Substitute, Mechanically Expandable was made, and it’s referred (definition in PCS) to as “SpineJack System”. This new technology helps to treat vertebral compression fractures that require a combination of repositioning to the correct height and placement of bone glue to stabilize the fracture. SpineJack® adds two mechanically expandable devices to the inside of the vertebral body and then places the cement around the devices. The New Technology Supplement code in the XNU table captures both processes in one code.
In addition to all the “new” information above, CMS released on July 30th some additional new PCS codes in response to COVID-19 treatment. CMS stated, “it is critical to be able to track the use of these treatments and their effectiveness in real-time.”
There is a total of twelve (12) new infusion and therapeutic codes and here are three examples:
XW013F5 Introduction of Other New Technology Therapeutic Substance into Subcutaneous Tissue, Percutaneous Approach, New Technology Group 5
XW033G5 Introduction of Sarilumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
XW043E5 Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5
These new PCS codes went into effect August 1 and enable CMS to conduct real-time surveillance and obtain real-world evidence in how these drugs are working and provide critical information on their effectiveness and how they can protect patients. These procedure codes are designated as non-O.R. procedures, there is no assigned MDC or MS-DRG.
In addition, there were two new guidelines for PCS (B3.18 and B5.2b) as well as two revisions (B3.1b and B3.10c) were made. Be sure to read through the PCS guidelines so that you are up to date; see the link below.
Keep in mind that STAR Auditing is offering educational webinars regarding the code updates, so check out the information on the website and be sure to register.
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