ICD-10-PCS Code Updates, April 2024

In this Coding Tip, we present the new ICD-10-PCS procedure codes that will go into effect on April 1, 2024.

As you know, CMS and the CDC release the majority of code changes for the fiscal year on October 1 each year. However, they are now making a second release of updates, as well as an update to the grouper, that become effective on April 1 of each year. This Coding Tip presents the ICD-10-PCS code changes that will go into effect on April 1, 2024.

To ensure you are current on all ICD-10 code updates, read ICD-10-CM CODE CHANGES EFFECTIVE APRIL 1, 2024.

Where can I find the updates?

To download the updated files, use this link to the CMS website: https://www.cms.gov/medicare/icd-10/2024-icd-10-pcs The files include an updated version of the guidelines, the index and the code tables as well as an addendum with files that include only the specific changes being made to the classification. Reviewing the addendum makes it easy to see exactly what is being changed/updated.

ICD-10-PCS Code Updates

The April 1, 2024, update includes changes to five sections of ICD-10-PCS with the greatest number of changes being made in the Medical and Surgical section.

Here is a summary of the April 1, 2024, changes:

Medical and Surgical (Section 0)

The are 12 code tables in the Medical and Surgical section of ICD-10-PCS that have updates for April 1, 2024.

The changes to six of the tables were made to accommodate the addition of Qualifier value G, Hand-Assisted. In hand-assisted laparoscopic surgery (HALS) the surgeon’s hand is placed in a sleeve and inserted through a small incision into the abdomen. Visualization of the operative site is still achieved laparoscopically, but the hand of the surgeon is present at the operative site which allows manual performance of techniques such as exposure, traction, palpation, and digital dissection of the operative specimen as would be seen in an open procedure. Another advantage of the presence of the hand is the ability to quickly control bleeding should an intraoperative hemorrhage occur.  

This change is found in the tables, and for the body parts, listed below. Note that every table has a Root Operation of either Excision or Resection, and by virtue of its nature, this qualifier is only available for procedures performed via the Percutaneous Endoscopic approach.

07T Medical and Surgical, Lymphatic and Hemic Systems, Resection

• Spleen (P)

0DB/T Medical and Surgical, Gastrointestinal System, Excision/Resection

• Large Intestine, Right (F)
• Large Intestine Left (G)
• Appendix (J)
• Transverse Colon (L)
• Descending Colon (M)
• Sigmoid Colon (N)

0FB/T Medical and Surgical, Hepatobiliary System and Pancreas, Excision/Resection

• Liver (0)
• Liver, Right Lobe (1)
• Liver, Left Lobe (2)
• Gallbladder (4)
• Pancreas (G) 

0TT Medical and Surgical, Urinary System, Resection

• Kidney, Right (0)
• Kidney, Left (1)
• Kidney, Bilateral (2)

At times is can be difficult to determine which ICD-10-PCS approach should be assigned when coding procedures that involve endoscopic instrumentation.  ICD-10-PCS Approach guidelines B5.2a and B5.2b provide help in making that decision.   

Guideline B5.2a makes it clear that open procedures, those where the operative site is exposed to the point that the surgeon can visualize the site with the naked eye, are coded to the approach Open, even if a scope is used to facilitate performance of the procedure.   

Open approach with percutaneous endoscopic assistance
B5.2a
Procedures performed using the open approach with percutaneous endoscopic assistance are coded to the approach Open.
Example: Laparoscopic-assisted sigmoidectomy is coded to the approach Open.

Guideline B5.2b explains that for those procedures where the surgeon is using a scope to visualize the site and perform the procedure, even if the surgeon’s hand is inserted through a port and used to assist with the surgery, the correct approach is Percutaneous Endoscopic. After April 1, 2024, codes for these procedures will also need a qualifier to indicate “Hand-Assisted”.   

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

COMING SOON…a new HIAlearn course on assignment of ICD-10-PCS Approach! Be sure to watch for this instruction with more in-depth information about coding hand-assisted procedures.

The remaining six tables in the Medical and Surgical section have various changes unique to the specific table.

00H Medical and Surgical, Central Nervous System, Insertion

• For procedures performed on the body part Brain through an Open approach, a Device character value 5, Radioactive Element, Palladium-103 Collagen Implant was added.

025 Medical and Surgical, Heart and Great Vessels, Destruction

• The Body Part value of 8, Conduction Mechanism was removed from the first row and added to two new rows to accommodate the addition of Qualifier value F Irreversible Electroporation. This qualifier is only available for procedures performed via the Percutaneous approach.

097 Medical and Surgical, Ear, Nose, Sinus, Dilation

• A new Body Part value of N was added to this table to allow for reporting of Dilation of the Nasopharynx.

0DX Medical and Surgical, Gastrointestinal System, Transfer

• A new Body Part value U, Omentum was added to this table to allow reporting of procedures where a portion of the omentum is moved to take over the function of another body part. In this table the Qualifier identifies the body part or body region whose function is being taken over in full or in part. Thus, new qualifier values were also added to this table, each of which corresponds to one of the following body regions:
  • Thoracic (V)
  • Abdominal (W)
  • Pelvic (X)
  • Inguinal (Y)

The last two tables in the Medical and Surgical section with updates are tables with the Root Operation Detachment, which are only found in the Anatomical Regions, Upper and Lower Extremities, Body Systems. The changes to these tables involve the removal of Qualifier value 2, Mid as an option for these specific body parts. When one of these body parts is amputated, the coder may now only report a complete, high or low amputation.  

0X/Y6 Medical and Surgical, Anatomical Regions, Upper/Lower Extremities, Detachment

• Thumb, Right (L)
• Thumb, Left (M)
• 1^st Toe, Right (P)
• 1^st Toe, Left (Q)

Administration (Section 3)

One new code was added to the Administration section of ICD-10-PCS.  In this section, the Body System/Region character value of Pleural Cavity, got a new value of “1 Thrombolytic” for the Substance character and “7 Other Thrombolytic” was added as a value for the Qualifier character in table 3E0 Administration, Physiological Systems, Introduction. The addition of these character values allows for reporting the introduction of thrombolytics into the pleural cavity to aid in the drainage of intrapleural effusions. In ICD-10-PCS, the medication represented by the character value “Thrombolytic” is tissue plasminogen activator (tPA) (r-tPA). The articles at the links below provide additional details about intrapleural thrombolysis.

• The use of thrombolytics in the management of complex pleural fluid collections - PMC (nih.gov)
• The Use of Intrapleural Thrombolytic or Fibrinolytic Therapy, or Both, via Indwelling Tunneled Pleural Catheters With or Without Concurrent Anticoagulation Use - CHEST (chestnet.org)
• Use of Fibrinolytics in Abdominal and Pleural Collections - PMC (nih.gov)

Extracorporeal or Systemic Assistance and Performance (Section 5)

There is one change in this section that consists of revising the title of value A for the Qualifiercharacter from High Nasal Flow/Velocity to High Flow/Velocity Cannula. This does not constitute a change in how these procedures are coded.

Mental Health (Section G)

Changes to the Mental Health section include the deletion of two codes from code table GZB Electroconvulsive Therapy. Two values 1, Unilateral – Multiple Seizure and 3, Bilateral – Multiple Seizure are being deleted as options for Character 4, Qualifier.

New Technology (Section X)

Two of the new codes effective April 1, 2024, are found in the New Technology section of ICD-10-PCS. For codes beginning with XW013 New Technology, Anatomical Regions, Introduction, Subcutaneous Tissue, Percutaneous, a new Substance value 2, Talquetamab Antioneoplastic was added to New Technology Group 9. This same code group (XW013) has a second update where the substance 4, Teclistamab Antineoplastic, from New Technology Group 8, was moved to its own row. Both Talquetamab and Teclistamab are bispecific antibodies used in the treatment of multiple myeloma. The brand names for these medications are Talvey and Tecvayli, respectively.

The second new code being added to the New Technology section is found in table X22 New Technology, Physiological Systems, Monitoring, which you may remember was a new table for the October release of ICD-10-PCS 2024. The last row of this table was added for the April 1, 2024, release.

This row generates code XX2KXP9 Monitoring of Interstitial Fluid Volume, Sub-Epidermal Moisture Using Electrical Biocapacitance in Subcutaneous Tissue, External Approach, New Technology Group 9. Subepidermal moisture level can be an early indicator of pressure damage to local skin and tissue. Inflammation triggered by tissue injury increases blood flow to the injured area, resulting in fluid accumulation below the epidermis known as subepidermal moisture (SEM). This accumulation can be assessed using an SEM scanner. Using Subepidermal Moisture Level as an Indicator of Early Pressure Damage to Local Skin and Tissue - PubMed (nih.gov)

Note that there are also updates to the Alphabetic Index and the ICD-10-PCS Character Definitions, so coders should download all the files from the CMS.gov website listed below to have a complete copy of the changes/updates going into effect on April 1, 2024, to use as a reference when coding. 

References

https://www.cms.gov/medicare/icd-10/2024-icd-10-pcs

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