ICD-10 Coordination and Maintenance Committee Meeting Discusses Impending Code Updates
By Maria Ward, MEd, RHIT, CCS-P, and Donna Rugg, RHIT, CCS, CDIP
The freeze is over! After five years of ICD-10 classification system code freezes, October 1, 2016 will see the system back on the “normal” cycle for annual updates. On March 9th and 10th, the ICD-10 Coordination and Maintenance committee met to review proposals for both ICD-10-CM and ICD-10-PCS that (if approved) would be included in the October 1, 2017 classification system addenda for fiscal year 2018.
Pat Brooks, senior technical advisory at the Centers for Medicare and Medicaid Services (CMS), opened the meeting on March 9 and welcomed all to the very first meeting after a “very successful implementation of ICD-10.” While no final decisions were made at this meeting, CMS did provide their recommendations for what they thought would be a good final code description, but encouraged written comments to be submitted. Comments for PCS need to be submitted by April 8, 2016 to the email address ICDprocedurecoderequest@CMS.HHS.gov. The proposed rule will be available in April, with the final rule August 1, 2016. June 2016 is when the full final code updates and addendum will be published. The next meeting will be September 13 – 14, 2016, and any new requests can be submitted to Brooks at firstname.lastname@example.org.
All PCS codes to date that have been approved as new, revised, and deleted have been compiled into a file for review under the Coordination and Maintenance Committee meeting materials. For the October 1, 2016 update, there are currently 75,625 PCS codes for the FY 2017 update, which includes 3,651 new codes and 487 revised code titles. Of the 3,651 new codes, 3,549 are cardiovascular system codes. These relate to unique device values, the addition of bifurcation as a qualifier, and additional specific body parts, as well as congenital cardiac procedures and placement of an intravascular neurostimulator. All of the revised code titles, so far, have come from changing the number of coronary artery sites to the number of vessels, and the specification of the descending thoracic aorta. Additional new codes include the expansion of the body part detail in Removal and Revision of lower joints, and the addition of unicondylar knee replacement. The codes presented at this meeting were for implementation in October 2016, according to Brooks, and will be added to the already-approved list.
The March 9, 2016 meeting contained 13 PCS proposals, most of which were recommendations for the New Technology section for FY2017. Many comments were made by the audience present at the meeting about the frequent use of the New Technology section and encouraged that, if applicable, items should be placed in the appropriate sections rather than in New Technology. Topics presented for the New Technology application included spinal fusion with Titan Spine EndoSkeleton nanoLOCK™, administration of Andexanet Alfa, insertion of endobronchial coils, minimally invasive aortic valve replacement with the EDWARDS INTUITY Elite™ Valve System, GORE® EXCLUDER® Iliac Branch Endoprosthesis, administration of Defibrotide, administration of VISTOGARD® uridine triacetate, insertion of MAGEC® spinal Bracing and Distraction system, and application of MIRODERM™ Biologic Wound Matrix. Additional proposals were:
- For repair of total anomalous pulmonary venous return (TAPVR), additional qualifiers were requested to describe a bypass to the appropriate body part value
- Additional qualifiers to identify related vs. unrelated donors since allogeneic can be either
- Addition of oxidized zirconium on polyethylene bearing surface for hip and knee arthroplasty
- Addition of a unique value for use of intraoperative fluorescence vascular angiography
Donna Pickett, medical systems administrator at the Centers for Disease Control and Prevention (CDC), opened day two of the meeting with continuing discussion of the ICD-10-CM proposals that began the day before. She reminded everyone that all the proposals discussed were targeted for the 10/1/17 addenda with the exception of the proposals related to the Zika virus, sacral dimple, classification of myocardial infarction, and the seroma codes which have been requested to be considered for inclusion in the 10/1/16 addenda. Pickett indicated that there were approximately 1,900 new diagnosis codes, 313 deleted codes, and 351 revised codes included in the FY2017 addenda. She also mentioned that over 160 proposals for code additions/revisions/deletions have been warehoused over the last five years due to the code freeze.
There were 24 diagnosis proposals on the agenda for discussion such as:
- Clostridium Difficile: A proposal was presented to expand the code to differentiate recurrent c. diff. enterocolitis from enterocolitis not specified as recurrent.
- Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked.
- Myocardial infarction: Specify the types as defined by several professional cardiology organizations. A specific code was proposed for type 2 myocardial infarction due to demand ischemia or ischemic imbalance so that data can be captured. The additional myocardial infarction types (3, 4a, 4b, 4c, 5) would all be assigned to one ICD-10-CM code. There was much discussion on this proposal related to the code proposals as well as the indexing and impact on subsequent myocardial infarctions. This proposal was requested for inclusion in the 10/1/16 addenda.
- Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda which would be consistent with the World Health Organizations’s ICD-10 update.
To see the complete documentation on the code proposals discussed at the meeting use the following links under the Coordination and Maintenance committee:
- For the ICD-10-PCS proposals go to the CMS website: https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html
- For the ICD-10-CM proposals go to the CDC website: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm
The procedure and diagnosis agendas include a timeline that specifies dates for the committee meetings, due dates for comments, dates for submitting code proposals, and when the proposed and final addenda is published as well as links needed to access related documents.
All the proposals presented at the Coordination and Maintenance committee meeting this week are still proposals, nothing is finalized. There is a public comment period where all comments are submitted in writing to be reviewed by CMS and CDC before final decisions are made. Comments on any codes to be included in the FY 2017 addenda are due to the Coordination and Maintenance committee by April 8, 2016. Comments on codes for the FY 2018 addenda are due by May 6, 2016. This is your opportunity to participate in the process and have input on the codes before they are finalized into an addendum. Take the time to review the proposals and addenda and send in your thoughts. HIM coding professionals who work with the codes on a daily basis can give invaluable input on the code itself as well as the use and application of proposed codes that can assist in ensuring accurate data is obtained.
Maria Ward and Donna Rugg are directors of HIM practice excellence at AHIMA.