FY 2012 ICD-10-PCS Updates

By Theresa Rihanek, RHIA, CCS

Limited updates were made to ICD-10-PCS for fiscal year 2012 as set forth under the partial code freeze established by the ICD-9-CM Coordination and Maintenance Committee.¹ The freeze is intended to aid the transition to the new code set by limiting updates for 2012 and 2013 to essential changes, such as those necessary to capture new technologies or diseases.

Additions and deletions to ICD-10-PCS were made in tandem with updates made to ICD-9-CM procedure codes. Other additions, revisions, or deletions were made in response to public request or to improve consistency within the classification. A return to regular code updates will occur on October 1, 2014, for ICD-10-CM and ICD-10-PCS.

As with every code classification revision, it is vital for users to review what is new. The 2012 fiscal year ICD-10-PCS tables are available at www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp.

New Qualifiers

In the medical and surgical section, the new qualifier vertical was added in the table for the stomach body part. This was added in conjunction with the new procedure code for laparoscopic vertical (sleeve) gastrectomy (48.32) in ICD-9-CM.

A new qualifier, left atrial appendage, was added for the left atrium body part to describe procedures performed on the left atrial appendage in the medical and surgical section.

In the administration section, root operation introduction, a new qualifier was inserted for anti-infective envelope in the subcutaneous tissue body system. This qualifier specifies the placement of an antimicrobial envelope around devices such as pacemaker generators.

Device Value Updates

In response to public comment, the device value for internal fixation device present within the fusion root operation relative to spinal joint body parts was deleted. This change also resulted in revision of ICD-10-PCS Coding Guideline B3.10c. The guideline no longer references internal fixation devices.

Laser interstitial thermal therapy modality qualifiers were added in the radiation oncology section to capture respiratory, breast, and prostate body part values.

Two new device classification maintenance standards were established:

• Device information is contained only within the device character.
• ICD-10-PCS contains a PCS-to-PCS Device Aggregation Table between root operations that use both general and specific devices and root operations such as removal and revision that only use general devices.²

Device values are intended to capture detail regarding the device. Qualifier values are to be used to capture essential detail about procedures that cannot be captured in the other characters. To remedy situations within ICD-10-PCS where device information was also being captured in the qualifier character, the device values were updated.

The sidebar at right details the device character update for external fixation devices in the upper bones body system. The device value definitions were expanded to capture the type of external fixation device in the device character rather than the qualifier character.

The second device classification maintenance standard requires that ICD-10-PCS contain information that correlates a specific device value used in the original root operation where the device was placed with its more general device value used in other root operations.³ Example root operations that involve device placement include bypass, insertion, occlusion, and drainage. The device aggregation table was developed to capture this information.

In a hip joint replacement procedure, the specific device value (i.e., synthetic substitute or ceramic on ceramic) is used in the root operation replacement. The removal of this specific device is captured with the general device value (synthetic substitute) with the root operation removal. The device aggregation table links the specific device value to the general device to help users determine the correct value for appropriate code assignment or code interpretation.

Updates were made in various tables to the device character to identify general device values where necessary.

Another new feature of ICD-10-PCS is the addition of the device key table. The table consists of two columns: one for the device name, including the brand or common name, and the other for the PCS device value.

The device key includes more than 300 entries. The device key is a valuable reference tool that will help ensure coding consistency and interpretation of ICD-10-PCS codes.

Notes

1. Centers for Medicare and Medicaid Services. "Partial Code Freeze for ICD-9-CM and ICD-10 Finalized." www.cms.gov/ICD9ProviderDiagnosticCodes/Downloads/Partial_Code_Freeze.pdf.
2. Centers for Medicare and Medicaid Services. "ICD-10-PCS FY2012 Version: FY 2012 Update Summary." www.cms.gov/ICD10/Downloads/pcs_whats_new_2012.pdf.
3. Centers for Medicare and Medicaid Services. "2012 ICD-10-PCS and GEMs." www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp.

Theresa Rihanek (theresa.rihanek@ahima.org) is professional practice director at AHIMA.