Dive into Synopsis of FY 2023 ICD-10-PCS Codes & Guidelines
CMS released the FY 2023 ICD-10-PCS codes and guidelines, effective on October 1, 2022. In summary, the update notes that there are 331 new and 64 deleted codes, totaling 78,496 ICD-10-PCS codes for 2023.
2023 ICD-10-PCS Guideline Changes
New guideline B3.19 Detachment procedures of extremities includes details on the qualifiers used for this root operation and definitions for complete and partial amputation of the hand and foot. This information was previously available in the ICD-10-PCS Reference Manual, which is now in the archive; the definitions are now a part of the Official Guidelines. The Guideline B4.1c revision clarifies that this guideline applies specifically to single vascular procedures that involve arterial or venous body parts. Guideline B6.1a is also revised to add the words “an event documented” to the example given for a complication necessitating both the insertion and the removal of the device before the end of the operative episode.
The addendum document includes files for the code table addenda as well as for the index and definitions reference.
The 2023 ICD-10-PCS Update Presentation outlines the below changes, effective October 1st, 2022. Learners will review the new and revised codes and guidelines. The course discusses the Medical and Surgical, Medical and Surgical-Related, and Ancillary sections.
Relocation of Codes to Medical and Surgical Section
Some of the changes for 2023 relocate codes. For example, Laser Interstitial Thermal Therapy (LITT) codes were deleted from the Radiation Therapy section and added to the Medical and Surgical section. This change was made because the procedure does not use ionizing radiation but rather thermal therapy to destroy soft tissue using heat generated by a laser probe. The codes are now added as Destruction procedures in the Medical and Surgical section in applicable body systems, with the LITT reflected in the qualifier value. For example, percutaneous endoscopic LITT of the brain is coded as 00504Z3.
Codes for replacement of the aortic valve with zooplastic tissue using the Rapid Deployment Technique are in the 02R table with the technique in the qualifier value. These codes are deleted from the New Technology section after data review justified identifying the technology in the Medical and Surgical Section.
Medical and Surgical Section Additions
Other changes to the Medical and Surgical section include codes for:
- Extraction of the cerebellum for procedures such as cavitron ultrasonic surgical aspiration (CUSA) for brain tumors
- Occlusion of prostatic artery for embolization procedures
- Transfer of small and large intestine for procedures such as bladder augmentation and ileal ureter surgery
- Removal and Revision of Infusion device from the skull – for these procedures on previously inserted devices such as an Ommaya reservoir
- Drainage of the neck via a natural or artificial opening or natural or artificial opening endoscopic approach for drainage of parapharyngeal or retropharyngeal abscesses using a laryngoscope
Changes to Other Sections
There were changes to other sections of PCS including:
- Introduction of other therapeutic monoclonal antibody via peripheral and central vein and other therapeutic substance into bones
- Changes in the Extracorporeal or Systemic Assistance table for coding of cardiac perfusion with intra-arterial supersaturated oxygen
New Technology Section
The New Technology or “X” codes had several updates for 2023, including some code deletions and additions (CMS). Additions include codes for:
- Implantation of Sphenopalatine Ganglion Stimulator for Ischemic Stroke
- Paired Vagus Nerve Stimulation Therapy Using an External Controller
- Computer-Assisted Transcranial Magnetic Stimulation of the Prefrontal Cortex
- Histotripsy of Liver
- Posterior Vertebral Tether procedures
- Insertion in Bones and Fusion in Joints for Internal Fixation Devices with Tulip Connector
- Insertion of posterior spinal motion preservation device in joints
- Replacement of lateral and medial meniscus
- Numerous new codes for Introduction of substances are included in the XW0 code table; all codes have an eight as the qualifier value for New Technology Group 8, and several new codes for Transfusion are found in the XW1 table, also with the qualifier value of 8.
- The XXE table has several new codes for Measurement techniques, and table XY0 includes a new code for Extracorporeal Antimicrobial Administration during Renal Replacement.
Many New Technology codes associate with applications for New Technology Add-on Payment (NTAP). Information on the status of these applications is in the Final Rule for IPPS.
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