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April 24, 2015


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Medical Coding News

 

Five New PCS Codes Recommended for Fall 2015 Implementation

 
April 24, 2015

Based on the March 18 and 19 meeting of the ICD-10 Coordination & Maintenance Committee meeting, it is full steam ahead to implementation of ICD-10 this fall.

Among the highlights of the meeting:
  • No new ICD-10-CM diagnosis codes are proposed for implementation October 1, 2015.
  • It is looking like there will be a new section X created for ICD-10-PCS that will contain codes for new technologies, specifically drugs and supplies, that are not adequately captured in the coding system as it stands now.
  • CMS is recommending five new ICD-10-PCS codes for implementation this fall.
  • CMS will post the general equivalence mappings (GEMs) in June of this year, earlier than usual (GEMs provide crosswalks between ICD-9-CM and ICD-10 codes) so as to give those implementing the new system plenty of time to prepare.

The new X code section would help fill in some gaps in the ICD-10-PCS coding system that arise with the use of new technology, drugs, or supplies, much as category III codes enable emerging technologies, services, and procedures to be reported in the CPT system. The aim is to create codes that uniquely identify procedures not captured in PCS while maintaining continuity with other sections of the coding sytem.

The only code additions to ICD-10-PCS CMS is recommending for October 1, 2015, implementation are X codes. The sixth digit (Device/Substance/Technology) would identify each drug or supply by name, and the seventh digit (Qualifier) would indicate the year the code would be implemented. Codes implemented in 2015 would be given the seventh digit of “1,” in 2016, the seventh digit of “2,” etc.

Below are code tables outlining the codes for which CMS is recommending a Qualifier of “1”:

Section X New Technology
Body System W Anatomical Regions
Operation 0 Introduction: Putting or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products
Body Part Approach Device/Substance/Technology Qualifier
3 Peripheral Vein
4 Central Vein
3 Percutaneous 5 Blinatumomab Antineoplastic
3 Idarucizumab, Dabigatran Antidote
4 Isavuconazole Anti-infective
1 New Technology Group 1

Section X New Technology
Body System R Joints
Operation 2 Monitoring: Determining the level of a physiological or physical function repetitively over a period of time
Body Part Approach Device/Substance/Technology Qualifier
G Knee Joint, Right
H Knee Joint, Left
0 Open 2 Intraoperative Knee Replacement Sensor 1 New Technology Group 1

Section X New Technology
Body System 2 Cardiovascular System
Operation C Extirpation: Taking or cutting out solid matter from a body part
Body Part Approach Device/Substance/Technology Qualifier
0 Coronary Artery 3 Percutaneous 6 Orbital Atherectomy Technology 2* New Technology Group 1

* As of publication time, it is uncertain whether character 1 for October 2015 or 2 for 2016 would be used pending the approval process.

For detailed descriptions of the new technologies above, visit the following link on the CMS web site, beginning on page 13: http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/Downloads/2015-03-18-Agenda.pdf.

CMS is planning to post final code updates and the addendum for fiscal 2016 on its web site in June 2015.

 

 

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