June/July 2018

Coding Corner: A Look at the Proposed 2019 ICD-10 Codes
By Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS
For The Record
Vol. 30 No. 6 P. 8

The ICD-10 Coordination and Maintenance Committee recently held its annual spring meeting Baltimore. A total of 15 procedure codes and 26 diagnosis codes were put forward for consideration for fiscal year (FY) 2019.

ICD-10-CM
The following table delineates the proposed changes to ICD-10-CM.

ICD-10-PCS
Thirteen ICD-10-PCS code changes were introduced to be considered for FY 2019 (October 1, 2018) implementation. Two requests were denied. The Centers for Medicare & Medicaid Services (CMS), which is seeking public input on three requests, approved eight that will be implemented on October 1, 2018.

CMS Seeking Public Input on Three Requests
• Irreversible Electroporation: currently coded using codes in section 0F5, Destruction

Option 1: Do not create new code. Continue using codes in section 0F5.

Option 2: Request for new qualifier value F.

Option 3: Request for new qualifier values F, G, H, J.

Interim coding advice: Continue to assign current codes from table 0F5, Destruction of Hepatobiliary System and Pancreas.

• Cell Suspension Autografting: currently split-thickness skin harvest is coded using the appropriate body part in table 0HB along with qualifier Z

Option 1: Do not create new code. Continue using codes in section 0HB.

Option 2: Create new qualifier Partial Thickness, Cell Suspension in table 0HR.

Option 3: Create a new code in Section X to identify cell suspension autografting.

Option 4: Create a new code in the Administration section to identify cell suspension autografting.

Interim coding advice: Continue to assign current codes from table 0F5, Destruction of Hepatobiliary System and Pancreas.

• Insertion of the Remedê Phrenic Nerve Stimulation System

Option 1: Do not create new code. Continue using codes 0JH60DZ and 05H03MZ and 05H33MZ or code 05H43MZ.

Option 2: Create new qualifier value 0 Pericardiophrenic Vein in table 05H.

Option 3: Create new codes in Section X, New Technology to identify the two major components of the system.

Interim coding advice: Continue to report insertion of phrenic nerve stimulation system as shown in Option 1.

CMS Approves Eight Requests — Effective Implementation Date October 1, 2018
• Partial Knee Joint Replacement; Femoral Modular Head; and Articulating Spacer for Hip and Knee Joints: Options 2, 3, 4 approved

Option 2: In the Lower Joints body system, revise the device value Synthetic Substitute, Unicondylar to Synthetic Substitute, Unicondylar Lateral. Add new device values Synthetic Substitute, Unicondylar Medial and Synthetic Substitute, Patellofemoral to the root operation Replacement table 0SR and root operation Removal table 0SP for the knee joint body part values.

Option 3: In the Lower Joints body system, add new device value Modular Head to the root operation Supplement table 0SU and the root operation Removal table 0SP for the hip joint femoral surface body part values.

Option 4: In the Lower Joints body system, add new device value Spacer, Articulating to the root operation Supplement table 0SR and the root operation Removal table 0SP for the hip joint and knee joint body part values.

Interim coding advice:

- Continue to code the removal of a knee joint prosthesis, or the replacement of all or part of the knee joint with a prosthetic component, using the device value Synthetic Substitute, and the most specific available knee joint body part values for the procedure performed, as shown in tables 0SP and 0SR.

- Code the removal of a spacer from the hip or knee joint, or the insertion of a spacer in the hip or knee joint, using the device value Spacer, and the most specific available knee or hip joint body part values for the procedure performed, as shown in tables 0SP and 0SH.

• Endovascular Thrombectomy of Intracranial and Extracranial Arteries: Option 2 approved

In table 03C, Extirpation of Upper Arteries, create qualifier value 7 Stent Retriever to distinguish endovascular thrombectomy of intracranial and extracranial arteries using stent retriever from other extirpation procedures.

Interim coding advice: Continue to code endovascular thrombectomy of the intracranial and extracranial arteries to table 03C, Extirpation of Upper Arteries.

• Robotic Water Resection of the Prostate: Option 2 approved

Create a new code in Section X, New Technology, to identify Aquablation therapy used to resect the prostate.

Interim coding advice: Continue to use resection of prostate code 0V508ZZ. If desired, can also assign 8E0W8CZ to indicate robotic assistance.

• Administration of Plazomicin: Option 2 approved

Create new codes in Section X, New Technology, to identify intravenous infusion of plazomicin.

Interim coding advice: Continue to report administration of plazomicin if desired using code 3E03329 or 3E04329.

• Percutaneous Extracorporeal Membrane Oxygenation (ECMO) for Cardiopulmonary Insufficiency: Option 2 approved

In table 5A1, create new qualifier value F Membrane, Peripheral, for application to the Circulatory, Cardiac and Respiratory fourth character physiologic system values, with the duration value Continuous, and the function value Oxygenation. Revise the existing qualifier 3 Membrane to specify Membrane, Central.

Interim coding advice: Continue using code 5A15223 to report percutaneous ECMO.

• Spinal Fusion With Hydroxyapatite Enhanced Interbody Fusion Device: Option 3 approved

Create new codes in Section X, New Technology, to identify spinal fusion procedures that use a radiolucent PEEK interbody fusion device. Use the same spinal joint body part values as in the body system Upper Joints and Lower Joints of the Med/Surg section.

Interim coding advice: Continue to code spinal fusion procedures using the appropriate body part value in tables 0RG and 0SG, Fusion of Upper Joints and Fusion of Lower Joints, with the device value Interbody Fusion Device.

• Administration of GIAPREZA: Option 2 approved

Add new substance value Synthetic Human Angiotensin II to table XW0 in the New Technology section, to capture the administration of GIAPREZA.

Interim coding advice: Continue using code 3E033XZ or 3E043XZ to report administration of GIAPREZA.

• Transfer of Prepuce for Reconstruction: Option 2 approved

Add root operation Transfer, creating new table 0VX, for the Male Reproductive body system. Add qualifier values Urethra and Penis for the body part value Prepuce, to capture procedures utilizing the prepuce (foreskin) to correct genital malformations.

Interim coding advice: Continue to code reconstruction procedures that utilize the foreskin to repair the penile shaft to table 0VQ Repair, Male Reproductive System, with body part value S Penis and the appropriate approach. Continue to code reconstruction procedures that utilize the foreskin to repair the urethra to table 0TQ, Repair, Urinary System, with body part value D Urethra and the appropriate approach.

CMS requested input on all proposals, which was due by April 6. The final rule with links will be posted on August 1. Final code updates and addendum will be posted on the following websites in June:

• FY 2019 ICD-10-PCS (Procedures): http://cms.hhs.gov/Medicare/Coding/ICD10/index.html  

• FY 2019 ICD-10-CM (Diagnoses): www.cdc.gov/nchs/icd/icd10cm.htm  

— Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, is director of coding quality and professional development at TrustHCS.