Review the ICD-10-PCS 2021 Updates, Effective 10-1-2020

Review the ICD-10-PCS 2021 Updates, Effective 10-1-2020

This article will highlight the ICD 10 PCS 2021 updates and Guideline changes. It will also briefly present some of the code additions for the Medical and Surgical Section. For a description of all of the code changes, see the Coordination and Maintenance Committee Meeting materials. Information on these guidelines and ICD-10-PCS changes in the ICD-10 Updates collection by YES HIM Education.

CMS will publish the codes in the FY 2021 IPPS Final Rule, effective on October 1, 2020 (CMS, 2020). The first thing of interest is how many ICD 10 PCS 2020 codes we will have for 2021. According to the Update Summary, PCS has a total of 78,103 codes, with CMS adding 544 new codes.

ICD-10 Updates & Code Changes

The complete list of ICD 10 Updates and code changes is available at CMS via the 2021 Tables Addenda (2020). Background information about these changes is in the ICD-10 Coordination and Maintenance Committee Meeting materials.

ICD 10 PCS Guideline Changes for FY 2021

There are minimal edits to ICD-10-PCS guidelines 2020, but there are 2 new guidelines this year:

Guideline B3.10c for Fusion procedures of the spine previously read: If an interbody fusion device is used to render the joint immobile (alone or containing other material like bone graft), … This has been changed to read: If an interbody fusion device is used to render the joint immobile (containing bone graft or bone graft substitute), … This clarifies that bone graft or substitute must be used in a spinal fusion procedure.

B3.1b no longer includes the following statement, in preparation for new guideline B3.18:

Exception: Mastectomy followed by breast reconstruction, both resection and replacement of the breast are coded separately.

Guideline B3.18

New Guideline B3.18, Excision/Resection followed by Replacement:

When excising or resecting a body part and replacing it, identify distinct objectives by coding each procedure separately. Unless replacement requires it, one should not perform excision or resection.

Examples: Mastectomy followed by reconstruction; both resection and replacement of the breast are coded to fully capture the distinct objectives of the procedures performed. Maxillectomy with obturator reconstruction; both excision and replacement of the maxilla are coded to fully capture the distinct objectives of the procedures performed. Excisional debridement of tendon with skin graft; both the excision of the tendon and the replacement of the skin with a graft are coded to fully capture the distinct objectives of the procedures performed. Esophagectomy followed by reconstruction with colonic interposition; both the resection and the transfer of the large intestine to function as the esophagus are coded to fully capture the distinct objectives of the procedures performed.

Examples: Resection of a joint as part of a joint replacement procedure is considered integral and preparatory for the replacement of the joint and the resection is not coded separately. Resection of a valve as part of a valve replacement procedure is considered integral and preparatory for the valve replacement and the resection; thus, it is not coded separately.

Guideline B5.2b

The last new Guideline is B5.2b. Percutaneous endoscopic approach with extension of incision:

Procedures performed using the percutaneous endoscopic approach, with incision or extension of an incision to assist in the removal of all or a portion of a body part or to anastomose a tubular body part to complete the procedure, are coded to the approach value Percutaneous Endoscopic.

Examples: Laparoscopic sigmoid colectomy with extension of stapling port for removal of specimen and direct anastomosis is coded to the approach value percutaneous endoscopic.

Code laparoscopic nephrectomy with midline incision for removing the resected kidney to the approach value percutaneous endoscopic.

Code the robotic-assisted laparoscopic prostatectomy with extension of incision for removal of the resected prostate to the approach value percutaneous endoscopic.

Impact of FY 2021 Changes

Adding more code tables and values to existing tables enables accurate coding of procedures. ICD-10-PCS provides the intended specificity. As providers enhance medical procedures or develop new ones, it is critical that the codes match the actual procedure performed. It is difficult to perform the coding process when there is no viable option in an ICD-10-PCS Table.

For example, the Second Quarter Coding Clinic, 2020 provides 2 such scenarios. In these, there was no available code so use the closest available equivalent or option. Having the full array of possible values in the Tables permits consistency in coded data. Eventually, it will lead to the best reimbursement option for that specific procedure.

With the new codes and guidelines, we as coding professionals need to educate ourselves on this rapidly changing environment. YES HIM Consulting and associates consider this critical to the accurate coding process for ICD-10-PCS. Ongoing education on the new procedure codes will assist in assigning accurate codes. In addition, ongoing education improves coders’ understanding of how and when to use the procedure. They will also understand the technique used to perform it.

Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA, co-authored this article with Ann Zeisset, RHIT, CCS, CCS-P.