Take a Peek at 2018 ICD-10-PCS Updates

2018 updates

It’s only June of 2017, but for coders that means it’s time to start watching for 2018 updates. ICD-10-PCS files are already available for review. This inpatient coding system, which changes to the 2018 version on Oct. 1, 2017, will see 3,562 new codes and 646 deletions for a total of 78,705 codes in the next version. There will be 1,821 revisions, too. What’s changing? Here are some highlights.

Get Clued In to Code Set Changes

CMS helpfully offers an update summary. It pulls out three main changes to watch:

  • Revisions for clarity and usefulness in the Medical and Surgical section
  • Addition of endoscopic approaches to various tables
  • Guideline updates.

To view just the changes, download the Addendum from the CMS 2018 ICD-10-PCS and GEMs page.

Medical and Surgical: As you review the definitions addenda file, watch for deletions that have a related addition.

Example: For Section 0 (Medical and Surgical), Character 4 (Body Part), you’ll see “Delete” next to the ICD-10-PCS value Nose. But before you start wondering how you’ll report nose procedures, scroll down a bit to find the added value Nasal Mucosa and Soft Tissue. The terms in the definition for both values are the same.

Tables: The tables addenda file is more than 400 pages, so homing in on the changes specific to what you code will be important for manageable 2018 preparation.

Example: If you report procedures on the coronary arteries, check out the changes to the table for 3E0 with fourth character 7. You’ll see a new fifth character option 4 for Percutaneous Endoscopic.

Know What’s New for ICD-10-PCS Guidelines

The guideline changes you can expect to see came about in part from public comment. Something to keep in time next time you think of a suggestion!

Added: Totally Tubular New Guideline B4.1c

New guideline B4.1c (under B4, Body Part General Guidelines) clarifies coding procedures on tubular structures:

If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the furthest anatomical site from the point of entry.

Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part.

Revised: Completed Incomplete Procedure Guideline B3.3 

The wording for B3.3 will see some changes in the header and first sentence. The changes are in red:

Discontinued or incomplete procedures

If the intended procedure is discontinued or otherwise not completed, code the procedure to the root operation performed.

Revised: Root Operation Over Control Clarified in B3.7

Guideline B3.7 about Control will change the specified list of definitive root operations to a list of examples. The text involved in the changes is marked in red

2017: If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.

2018: If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then the more definitive root operation is coded instead of Control.

Revised: Temporary Device at Center of B6.1a

Under Device General Guidelines, B6.1a will see an expansion, with the addition of all the red text

A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. In limited root operations, the classification provides the qualifier values Temporary and Intraoperative, for specific procedures involving clinically significant devices, where the purpose of the device is to be utilized for a brief duration during the procedure or current inpatient stay.

How About You?

Have you reviewed the PCS files? What did you think of the changes?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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