ICD-10-PCS 2017 Guideline Changes: Multiple Procedures, Distinct Sites, Autografts

This installment of “In the kNOW” will continue to share ICD-10-PCS changes that will impact coders come October 1, 2016.  The focus in this issue will be on changes to the PCS guidelines.   

There were a few guidelines with minor wording changes or inclusion of more examples.  For instance, in guideline B3.2 that addresses the coding of multiple procedures that are performed during the same operative episode, a new example states that if there are multiple lesions being excised from the colon from different body parts (ascending and descending), then code both procedures.  

B3.4a clarified an example by providing additional information.  So the example “Fine needle aspiration biopsy of the lung”, now reads “Fine needle aspiration biopsy of fluid in the lung”.  The remainder of the example is the same, specifying that “Drainage” is the appropriate root operation for this procedure and a Diagnostic qualifier should be used for the biopsy.

The first major change to the guidelines occurs with B3.6b and shifts the focus from the number of distinct sites in coronary arteries to the actual number of coronary arteries involved.  Coders will see that the entire first sentence of the 2016 version of the guideline that specified “distinct sites” has been deleted.  In the last sentence the phrase “artery sites” was replaced with “arteries” to complete the switch.  No longer should coders code by number of arterial sites, but under these 2017 revisions, code the actual number of arteries.  This is reiterated in guideline B4.4 where the wording is changed from “number of sites treated” to “number of arteries treated”.  Coders are then instructed to use one procedure code specifying multiple arteries in situations where the same procedure is performed which would include the same device and qualifier values.     

The revision to B3.7 supports the root operation revision that was discussed in our first “In the kNOW” article.  It simply adds the phrase “or other acute bleeding” to the definition of “Control” and then proceeds to address the need to use a more definitive root operation in the event the bleeding remains uncontrolled.

The last change to discuss is that B3.9 was revised from “If an autograft is obtained from a different body part” to “If an autograft is obtained from a different procedure site”.  The remainder of the guideline stayed the same stating that a separate procedure for getting the graft should be coded, if it was necessary for completing the objective of the procedure. 

This link will direct you to the CMS webpage for everything ICD-10-PCS related: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html 

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.