FY 2024 Updates to ICD-10-PCS

Changes to the Medical and Surgical Section

New codes include the following:

• Insertion, Removal, and Revision of Short-term External Heart System
• Body Part of Larynx Added to Reposition Table for Mouth and Throat
• Insertion of a Magnetic Lengthening Device in the Gastrointestinal System
  • Upper
  • Middle
  • Lower esophagus
• Insertion of Extravascular Implantable Defibrillator Lead in the Mediastinum in the General Anatomical Regions.

Changes to table 02H Insertion of Heart and Great Vessels

Change to table 02P Removal of Heart and Great Vessels

Change to table 02W Revision of Heart and Great Vessels

Changes to table 0CS Reposition of Mouth and Throat

Changes to the table 0DH Insertion of Gastrointestinal System

Changes to table 0WH Anatomical Regions, General (Insertion)

Changes to table 0WP, Anatomical Regions, General (Removal)

Changes to table 0WW Anatomical Regions, General (Revision)

The Extracorporeal of Systemic Assistance and Performance section 5A0, qualifier character K - Intubated Prone Positioning, are added to Respiratory Body System. Using this method improves gas exchanges, reduces dorsal lung compression, and improves lung perfusion.

The prone method is used on patients who are diagnosed with moderate-to-severe acute respiratory distress syndrome (ARDS). Pay close attention to the respiratory flowsheet for the method used to intubate the patient if they are diagnosed with ARDS.

Another major addition occurred in the Other Procedures, Physiological Systems, and Anatomical Regions: Female Reproductive System and Trunk. CYTALUX® (Pafolacianine) is an FDA-approved prescription medication that is infused one hour to nine hours before the start of an ovarian surgery, and one hour to 24 hours before the start of a lung procedure. This medication has a dye that lights up when a specific camera, called infrared imaging system, is used. This new breakthrough assists surgeons in visualizing ovarian and lung cancer lesions during surgery.

Changes to New Technology Section:

CMS made several additions to the New Technology Group by adding 40 new codes. These procedures are for new substances and devices that currently do not have a permanent code; they are temporary until further notice. They also provide a new technology add-on payment (NTAP) to the overall reimbursement when administered to patients. There are five new tables added to this section. Below are some examples:

• X05 (New Technology Section, Nervous System, Destruction)
  • Renal Sympathetic Nerve(s) via Percutaneous with Ultrasound Ablation; New Technology Group 9 (X051329)
• X2H (New Technology Section, Cardiovascular System, Insertion)
  • Inferior Vena Cava via Percutaneous approach, Intraluminal Device/Bioprosthetic Valve; New Technology Group 9 (X2H03R9)
• X2U (New Technology Section, Cardiovascular System, Supplement)
  • Coronary Artery/Arteries via Open approach, Vein Graft Extraluminal Support Device(s); New Technology Group 9 (X2U4079)
• XNR (New Technology Section, Bones, Replacement)
  • Skull via Open approach, Synthetic Substitute, Ultrasound Penetrable; New Technology Group 9 (XNR80D9)
• XX2 (New Technology Section, Physiological Systems, Monitoring)
  • Central Nervous via External approach, Brain Electrical Activity, Computer-aided Detection and Notification; New Technology Group 9 (XX20X89)

There are new codes in existing tables as well; below are some examples:

• XXE2X19: Measurement of Cardiac Output Computer-aided Assessment, External
• XNHG0F9: Insertion Tibial Extension with Motion Sensors of the Right Tibia, Open approach
• XRGK0B9: Fusion of the Left Ankle, Internal Fixation Device, Open-truss Design, Open approach

There are two new codes for the treatment of COVID-19 in table XW0’s New Technology Group 9.

Many of the new technology codes may be eligible for NTAP including the procedure code for CYTALUX®.

In the Medical and surgical section, the following were changes:

The following were added to the Body Part Key:

• Appendiceal Orifice
• Middle meningeal artery, intracranial portion
• Chin

The following were added to the Device Key in the Medical and Surgical Section:

• EV ICD System (extravascular implantable defibrillator lead)
• Aveir™ VR, as single chamber
• Flourish® Pediatric Esophageal Atresia Device
• Aortix™ System
• Vanta™ PC Neurostimulator; and
• Intellis™ Neurostimulator.

The following was were added to the Device Key in the Administration Section:

• Plazpmicin- under Other Anti-Infective
• Angiotensin Ⅱ*
• GIAPREZA™*
• Human angiotensin Ⅱ, synthetic*

*Note: The final three are under vasopressor.

Changes to PCS Guidelines

For 2024, two ICD-10-PCS guidelines were revised, due in part to public comment and internal review by CMS:

• B5.2b – Body part general guideline
• B6.1a – Device general guideline

B5.2b Percutaneous endoscopic approach with hand-assistance or extension of incision

Procedures performed using the percutaneous endoscopic approach with hand-assistance,

or with an incision or extension of an incision to assist in the removal of all or a portion

of a body part, or to anastomose a tubular body part with or without the temporary

exteriorization of a body structure, are coded to the approach value Percutaneous.

This guideline and definition were revised to include hand-assistance and temporary exteriorization of a body structure to arrive at the correct approach. Below are examples on how to apply this guideline:

• Hand-assisted laparoscopic sigmoid colon resection with exteriorization of a segment of the colon for removal of specimen with return of colon back into abdominal cavity is coded to the approach value percutaneous endoscopic.
• Laparoscopic sigmoid colectomy with extension of stapling port for removal of specimen and direct anastomosis is coded to the approach value percutaneous endoscopic.
• Laparoscopic nephrectomy with midline incision for removing the resected kidney is coded to the approach value percutaneous endoscopic.
• Robotic-assisted laparoscopic prostatectomy with extension of incision for removal of the resected prostate is coded to the approach value percutaneous endoscopic.

B6.1a Device general guidelines

The major change is the removal of the example, “the device size is inadequate, or an event documented as a complication occurs” from the guidelines.

Work with your specific department to identify any of these new technologies being used by your organization. Pay close attention to many changes to body part and qualifier values. Get to know the new and revised B5.2b and 6.1a 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.

Editor’s note: This article contains tables from the ICD-10-PCS Reference Manual.

Mazette H. Edwards, MA, CDIP, CCS, is the assistant vice president of revenue cycle at Northwell Health, the largest health care system in New York. Edwards has more than 25 years of experience in health information management, coding, and revenue integrity.