FY 2023 Updates to ICD-10-PCS

On May 26, 2022, the Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS code and guidelines changes for FY 2023. These 78,229 codes will take effect for discharges occurring from October 1, 2022, to September 30, 2023. There are 331 new procedure codes, 64 deleted procedure codes, and no revised titles. Changes to the guidelines include the addition of B3.19 for detachment, and revisions to B4.1c for tubular body part, and B6.1a for general coding of device.

This article summarizes the ICD-10-PCS code changes and new and revised guidelines.

ICD-10-PCS Procedure Changes FY 2023

Below are the areas where additions have been made:

• The Central Nervous System and Cranial Nerves section has a new qualifier 3 under root operation of Destruction to reflect use of using Laser Interstitial Thermal Therapy. Cerebrum now has its own body part under the root operation of extraction.
• In the Heart and Great Vessels section under root operation Replacement, qualifier N, Rapid Deployment Technique, was added to body part F, Aortic Valve, when zooplastic tissue is the qualifier.
• In the Lower Arteries, the root operation Occlusion in the Lower Arteries section has been updated to reflect right and left prostatic arteries as qualifiers V and W.
• The Respiratory, Gastrointestinal, Hepatobiliary, Endocrine, Skin and Breast, and the Male Reproduction systems have a major addition. The root operation Destruction using Laser Interstitial Thermal Therapy (LITT) is now represented by qualifier 3. LITT was relocated from the Radiation Therapy section.
• In the Gastrointestinal System section, root operation Transfer, bladder, left and right ureters, and bilateral ureters were added as qualifiers to Body Part small intestine.
• In the Head and Facial Bones section, infusion device was added to the sixth character under root operations Removal and Revision of the skull body part.
• The Anatomical Regions, General section, neck is now located above pelvic cavity. See sample of the table below.

• In the Extracorporeal of Systemic Assistance and Performance section, Body System Cardiac now has three entries. Pay close attention when selecting duration, function, and qualifier. Circulatory only has hyperbaric as a qualifier. See sample of the table below.

Changes to New Technology Section

CMS made several changes to the New Technology Group by adding 53 new codes with qualifier 8 and 31 code deletions. Many of the new technology codes may be eligible for New Technology Add-on Payment (NTAP). Below are some of the highlights:

• X0H - Insertion of Neurostimulator Lead into Sphenopalatine Ganglion, Vagus Nerve
• X0Z - Computer-assisted Transcranial Magnetic Stimulation of Prefrontal Cortex
• X2A - Intermittent coronary sinus occlusion
• XF5 - Destruction of liver using ultrasound-guided cavitation
• XKU - Supplement Upper Spine Bursa and Ligament with Posterior Vertebral Tether
• XNH - Insertion of Internal Fixation Device with Tulip Connector into Left or Right Pelvic Bone
• XRG - Fusion of Left or Right Sacroiliac Joint using Internal Fixation Device with Tulip Connector; Fusion using Interbody Fusion Device, Customizable
• XRH - Insertion of Posterior Spinal Motion Preservation Device into Lumbar and Lumbosacral Joints
• XRR - Replacement of lateral or medial meniscus with synthetic substitute
• XW0 - Introduction of Substance (several additions)
• XW1 – Transfusion of Substance into Central and Peripheral Vein
• XXE – Measurement of Coronary Artery Flow and Infection of whole blood; Measurement of Brain Electrical Activity with Computer-Aided Semiologic Analysis
• XY0 – Extracorporeal Antimicrobial Administration and Anticoagulant

2023 Additions and Changes to ICD-10-PCS Definitions

In the Medical and Surgical section, the changes are:

Character 4 – Body Parts

Character 6 – Device

Changes to ICD-10-PCS Guidelines

For 2023, we now have one new and two revised ICD-10-PCS guidelines:

• B3.19 – Detachment of extremities guideline
• B4.1c – Body part general guideline
• B6.1a – Device general guideline

B3.19 Detachment of extremities

This guideline and definitions were created to assist with applying the correct qualifier. Below is a table outlining the body part, the qualifier associated with it, and the definition. Review the examples and become familiar with the different qualifiers.

There are slight changes when coding amputation of Hand and Foot:

• “Complete” refers to amputation through the carpometacarpal joint of the hand, or through the tarsal-metatarsal joint of the foot.
• “Partial” refers to amputation anywhere along the shaft or head of the metacarpal bone of the hand, or of the metatarsal bone of the foot. 

B4.1c Body part general guidelines

Specifies that the procedure performed is a single vascular procedure on either the artery or vein and not just on a tubular body part. An example of this revised change: “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.”

B6.1a Device general guidelines 2022

There is a significant language change to this guideline. The major change is in the example, “(for example, the device size is inadequate, or an event documented as a complication occurs).” Be careful when interpreting and applying this guideline.

The FY 2023 ICD-10-PCS changes focus on aligning the procedures to their respective systems in the Medical and Surgical section. The moving of the LITT procedures from the Radiation Therapy section is one example. Pay close attention to the many changes to body part and qualifier values. Get to know the new B3.19 and the revised B4.1c and B6.1a guidelines. To prepare, know which of the changes will have a direct impact on your facility, not just the coding staff but also clinical documentation and the entire revenue cycle. Below are links to the official ICD-10-PCS guidelines and the FY 2023 ICD-10-PCS code set:

• 2023 ICD-10-PCS Official Guidelines for Coding and Reporting
• 2023 ICD-10-PCS

Mazette H. Edwards is the associate vice president of revenue cycle management at Northwell Health.