ICD-10-PCS Guideline Updates for FY2022: Key Changes

Caitlin Wham, CCS Medical Coding Leave a Comment

ICD-10-PCS Guideline Updates for FY2022: Key Changes

In 2021, CMS released the Official ICD-10-PCS Coding Guidelines for fiscal year 2022, which went into effect October 1st. The FY 2022 PCS guidelines include three guideline revisions in the Medical and Surgical section (B3.7, B4.1c, B4.8) and two guideline revisions from the New Technology section (E1.a, E1.b). Although key changes will be highlighted in this blog, be sure to review the 2022 ICD-10-PCS Official Guidelines for Coding and Reporting in their entirety to ensure proper coding and reporting.

Guideline B3.7 Control vs. More Specific Root Operations

Guideline B3.7 has been revised with more precise terminology. Clarification is given that the root operation “Control” is appropriate when: 1) A procedure performed to achieve hemostasis utilizes techniques that go beyond what is considered integral to the procedure and 2) The procedure is not described by a more specific root operation. The guideline has also been revised to include three examples for further clarification:

  • Silver nitrate cautery to treat acute nasal bleeding is coded to the root operation Control.
  • Liquid embolization of the right internal iliac artery to treat acute hematoma by stopping blood flow is coded to the root operation Occlusion.
  • Suctioning of residual blood to achieve hemostasis during a transbronchial cryobiopsy is considered integral to the cryobiopsy procedure and is not coded separately.

Guideline B4.1c Body Part—General Guidelines

This guideline and associated example were revised to clarify the correct body part character assigned when a procedure is performed on a continuous section of a tubular body part. The FY 2021 Guidelines stated the correct body part assigned was “the furthest anatomical site from the point of entry.” However, FY 2022 Guidelines now state the correct body part assigned is “anatomically most proximal (closest to the heart).” The associated example states:

“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. 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 external iliac artery is also coded to the external iliac artery body part.”

 

Be sure to refer to anatomy as needed to determine the body part closest to the heart for accurate code assignment.

Guideline B4.8 Upper and Lower Intestinal Tract

The root operation “Insertion” has been added to Guideline B4.8 after being left off inadvertently.

“In the Gastrointestinal body system, the general body part values Upper Intestinal Tract and Lower Intestinal Tract are provided as an option for the root operations such as Change, Insertion, Inspection, Removal and Revision.”

 

Note that although Insertion has been added to the guideline, this change did not result in any new codes as Table 0DH (below) was correct in FY2021 and is unchanged for FY2022.

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Guideline E1.a New Technology—General guidelines

The Example provided with Guideline E1.a has been revised as the previous code (XW04321 Introduction of Ceftazidime Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1) has been deleted. Although the Example has changed, the guidance remains the same.

“E1.a Section X codes fully represent the specific procedure described in the code title, and do not require additional codes from other sections of ICD-10-PCS. When section X contains a code title which fully describes a specific new technology procedure, and it is the only procedure performed, only the section X code is reported for the procedure. There is no need to report an additional code in another section of ICD-10-PCS. Example: XW043A6 Introduction of Cefiderocol Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 6, can be coded to indicate that Cefiderocol Anti-infective was administered via a central vein. A separate code from table 3E0 in the Administration section of ICD-10-PCS is not coded in addition to this code.”

 

Guideline E1.b. New Technology—General Guidelines

Similarly, Guideline E1.b was updated to replace the example of a magnetically controlled growth rod placed during spinal fusion. We now have a new example, regarding placement of an extracorporeal flow reversal circuit. Although the Example has changed, the guidance remains the same.

“When multiple procedures are performed, New Technology section X codes are coded following the multiple procedures guideline.

Examples: Dual filter cerebral embolic filtration used during transcatheter aortic valve replacement (TAVR), X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2, is coded for the cerebral embolic filtration, along with an ICD-10-PCS code for the TAVR procedure. An extracorporeal flow reversal circuit for embolic neuroprotection placed during a transcarotid arterial revascularization procedure, a code from table X2A, Assistance of the Cardiovascular System is coded for the use of the extracorporeal flow reversal circuit, along with an ICD-10-PCS code for the transcarotid arterial revascularization procedure.”

 

Additional Information

Additional information regarding ICD-10-PCS Guideline Updates for FY 2022 can be found below:

  • ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Pages: 99-100 Explanation of the revised guideline for control

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