Prepare for FY2020 Changes with Ease

FY2020 IPPS Changes

Sandra L Brewton, RHIT, CCS, CICA, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Senior Healthcare Consultant Panacea Healthcare Solutions, A Career Step Company

Tuesday, November 12, 2019

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Agenda  Overview of Changes  Review Changes/Revisions to Official Guidelines for ICD-10-CM and ICD-10-PCS  Discuss Key Code Changes for FY2020  CC/MCC Designation Changes  New Technology  ICD-11 Update from AHIMA

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Overview of FY2020 Rule The Final Rule

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IPPS FY20 Final Rule Overview  Released August 2019 (2,273 pages)  Thirteen changes to MS-DRGs  Shifts in MS-DRGs 981-983/987-989 (twelve)  Net relative weight change: +21.4779 • 335 relative weights decreased • 425 relative weights increased • 1 relative weight did not change

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IPPS FY20 Final Rule Overview  MS-DRGs with largest RW change • MS-DRG 229 was decreased 0.5435 • MS-DRG 927 was increased 1.5590  Two MS-DRGs eliminated • MS-DRG 691 • MS-DRG 692  Two MS-DRGs created • MS-DRG 319 • MS-DRG 320

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IPPS FY20 Final Rule Overview  New technology • 9 recommended for continuation from FY19 • 3 discontinued from FY19 • 9 new requests approved for FY20 • 4 requests not approved for FY20  Comments regarding IPPS are due by November 1, 2019, for next fiscal year • Send Comments to: -

MSDRGClassificationChange@cms.hhs.gov

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IPPS FY20 Final Rule Overview

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IPPS FY20 Final Rule Overview Table

Contents

5A

List of MS-DRGs and Associated Relative Weights

6A

List of New Diagnoses

6B

List of New Procedures

6I

Complete List of MCCs

6I.1

List of New MCCs

6J

Complete List of CCs

6J.1

List of New CCs

6J.2

List of Deleted CCs

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ICD-10-CM Guidelines FY2020 Revisions, Additions, Deletions

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Guideline Changes Format  Deletions are seen with strikethrough  Additions/New Guidelines are bolded.

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“With” The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.

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Sepsis or Severe Sepsis with Localized Infection 4) Sepsis and or severe sepsis with a localized infection If the reason for admission is both sepsis and or severe sepsis and a localized infection, such as pneumonia or cellulitis, a code(s) for the underlying systemic infection should be assigned first and the code for the localized infection should be assigned as a secondary diagnosis. If the patient has severe sepsis, a code from subcategory R65.2 should also be assigned as a secondary diagnosis. If the patient is admitted with a localized infection, such as pneumonia, and sepsis/severe sepsis doesn’t develop until after admission, the localized infection should be assigned first, followed by the appropriate sepsis/severe sepsis codes.

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Other Types of Myocardial Infarction 5) Other Types of Myocardial Infarction The ICD-10-CM provides codes for different types of myocardial infarction. Type 1 myocardial infarctions are assigned to codes I21.0-I21.4 and I21.9.

Type 2 myocardial infarction (myocardial infarction due to demand ischemia or secondary to ischemic imbalance) is assigned to code I21.A1, Myocardial infarction type 2 with the underlying cause coded first. Do not assign code I24.8, Other forms of acute ischemic heart disease, for the demand ischemia. If a type 2 AMI is described as NSTEMI or STEMI, only assign code I21.A1. Codes I21.01-I21.4 should only be assigned for type 1 AMIs.

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Pressure Ulcer Stage Codes 1) Pressure ulcer stages  Codes in category L89, Pressure ulcer, identify the site and stage of the pressure ulcer.  The ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1-4, deep tissue pressure injury, unspecified stage, and unstageable.

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Pressure Ulcer Stage Codes (cont.)

2) Unstageable pressure ulcers Assignment of the code for unstageable pressure ulcer (L89.--0) should be based on the clinical documentation. These codes are used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with the codes for unspecified stage (L89.--9).

When there is no documentation regarding the stage of the pressure ulcer, assign the appropriate code for unspecified stage (L89.--9).

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Pressure Ulcer Stage Codes (cont.)

7) Pressure-induced deep tissue damage For pressure-induced deep tissue damage or deep tissue pressure injury, assign only the appropriate code for pressure-induced deep tissue damage (L89.--6).

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Retained Products of Conception 2) Retained Products of Conception following an abortion Subsequent encounters for retained products of conception following a spontaneous abortion or elective termination of pregnancy, without complications are assigned O03.4, Incomplete spontaneous abortion without complication, or code O07.4, Failed attempted termination of pregnancy without complication. This advice is appropriate even when the patient was discharged previously with a discharge diagnosis of complete abortion. If the patient has a specific complication associated with the spontaneous abortion or elective termination of pregnancy in addition to retained products of conception, assign the appropriate complication code (e.g., O03.-, O04.-, O07.-) in category O03 or O07 instead of code O03.4or O07.4.

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Iatrogenic Injuries 3) Iatrogenic injuries Injury codes from Chapter 19 should not be assigned for injuries that occur during, or as a result of, a medical intervention. Assign the appropriate complication code(s).

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Physeal Fractures 3) Physeal Fractures For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.

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Two or More Drugs, Medicinal or Biological Substances 4) If two or more drugs, medicinal or biological substances  If two or more drugs, medicinal or biological substances are taken, code each individually unless a combination code is listed in the Table of Drugs and Chemicals.  If multiple unspecified drugs, medicinal or biological substances were taken, assign the appropriate code from subcategory T50.91, Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances.

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Complications of Care Codes within Body System Chapters 5) Complications of care codes within the body system chapters Intraoperative and postprocedural complication codes are found within the body system chapters with codes specific to the organs and structures of that body system. These codes should be sequenced first, followed by a code(s) for the specific complication, if applicable.

Complication codes from the body system chapters should be assigned for intraoperative and postprocedural complications (e.g., the appropriate complication code from chapter 9 would be assigned for a vascular intraoperative or postprocedural complication) unless the complication is specifically indexed to a T code in chapter 19.

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Body Mass Index Z68 Body mass index (BMI)  BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity) the associated diagnosis (such as overweight or obesity) meets the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). Do not assign BMI codes during pregnancy.

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Health Counseling Z71 Persons encountering health services for other counseling and medical advice, not elsewhere classified Note: Code Z71.84, Encounter for health counseling related to travel, is to be used for health risk and safety counseling for future travel purposes.

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Uncertain Diagnosis If the diagnosis documented at the time of discharge is qualified as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “still to be ruled out,” “compatible with,” “consistent with,” or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.

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ICD-10-CM 2020 Update

Code Changes

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Overview of Diagnosis Code Changes  273 New codes  30 Revised codes  21 Deleted codes  Total number of ICD-10-CM codes for FY2020 • 72,184

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FY2020 New Diagnosis Codes Ch. 3: Diseases of blood/blood-forming organs & Disorders involving immune system  D.75.A • Glucose-6 phosphate dehydrogenase (G6PD) deficiency w/o anemia  D81.30 • Adenosone deaminase deficiency, unspecified  D81.31 • Severe combined immunodeficiency due to adenosine deaminse deficiency  D81.32 • Adenosine deaminase 2 deficiency  D81.39 • Other adenosine deaminase deficiency

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FY2020 New Diagnosis Codes Subsegmental Pulmonary Embolism  I26.93 •

Single subsegmental pulmonary embolism without acute cor pulmonale

 I26.94 •

Multiple subsegmental pulmonary emboli without acute cor pulmonale

Atrial Fibrillation  I48.11 - Longstanding persistent atrial fibrillation  I48.19 - Other persistent atrial fibrillation  I48.20 - Chronic atrial fibrillation, unspecified  I48.21 - Permanent atrial fibrillation 31

FY2020 New Diagnosis Codes Phlebitis and Thrombophlebitis I80.241 - Phlebitis and thrombophlebitis of right peroneal vein I80.242 - Phlebitis and thrombophlebitis of left peroneal vein I80.243 - Phlebitis and thrombophlebitis of peroneal vein, bilateral I80.249 - Phlebitis and thrombophlebitis of unspecified peroneal vein I80.251 - Phlebitis and thrombophlebitis of right calf muscular vein I80.252 - Phlebitis and thrombophlebitis of left calf muscular vein I80.253 - Phlebitis and thrombophlebitis of calf muscular vein, bilateral  I80.259 - Phlebitis and thrombophlebitis of unspecified calf muscular vein       

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FY2020 New Diagnosis Codes Deep Vein Thrombosis  I82.451 •

Acute embolism and thrombosis of right peroneal vein

•

Acute embolism and thrombosis of left peroneal vein

•

Acute embolism and thrombosis of peroneal vein, bilateral

•

Acute embolism and thrombosis of unspecified peroneal vein

•

Acute embolism and thrombosis of right calf muscular vein

•

Acute embolism and thrombosis of left calf muscular vein

 I82.452  I82.453  I82.459  I82.461  I82.462

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FY2020 New Diagnosis Codes Deep Vein Thrombosis (cont)  I82.463 • Acute embolism and thrombosis of calf muscular vein, bilateral  I82.469 • Acute embolism and thrombosis of unspecified calf muscular vein  I82.551 • Chronic embolism and thrombosis of right peroneal vein  I82.552 • Chronic embolism and thrombosis of left peroneal vein  I82.553 • Chronic embolism and thrombosis of peroneal vein, bilateral

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FY2020 New Diagnosis Codes Deep Vein Thrombosis (cont)  I82.561 • Chronic embolism and thrombosis of right calf muscular vein  I82.562 • Chronic embolism and thrombosis of left calf muscular vein  I82.563 • Chronic embolism and thrombosis of calf muscular vein, bilateral  I82.569 • Chronic embolism and thrombosis of unspecified calf muscular vein

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FY2020 New Diagnosis Codes NEW! Pressure-Induced Deep Tissue Damage           

Elbows (L89.006-L89.026) Back Upper/Lower (L89.106-L89.146) Sacral region (L89.156) Hip (L89.206-L89.226) Buttock (L89.306-L89.326) Contiguous site back/buttock/hip (L89.46) Ankle (L89.506-L89.526) Heel (L89.606-L89.626) Head (L89.816) Other site (L89.896) Unspecified site (L89.96)

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FY2020 New Diagnosis Codes Breast Lump in Overlapping Quadrants  N63.15 • Unspecified lump in the right breast, overlapping quadrants  N63.25 • Unspecified lump in the left breast, overlapping quadrants Post Endometrial Ablation Syndrome  N99.85 - Post endometrial ablation syndrome

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FY2020 New Diagnosis Codes Congenital Deformities of Feet        

Congenital talipes equinovarus (Q66.00-Q66.02) Congenital talipes calcaneovarus (Q66.10-Q66.12) Congenital metatarsus (primus) varus (Q66.211-Q66.219) Congenital metatarsus adductus (Q66.221-Q66.229) Other congenital varus deformities of feet (Q66.30-Q66.32) Congenital talipes calcaneovalgus (Q66.40-Q66.42) Congenital pes cavus (Q66.70-Q66.72) Congenital deformity of feet, unspecified (Q66.90-Q66.92)

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FY2020 New Diagnosis Codes Ehlers-Danlos Syndromes (EDS)     

Q79.60 - Ehlers-Danlos syndrome, unspecified Q79.61 - Classical Ehlers-Danlos syndrome Q79.62 - Hypermobile Ehlers-Danlos syndrome Q79.63 - Vascular Ehlers-Danlos syndrome Q79.69 - Other Ehlers-Danlos syndromes

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FY2020 New Diagnosis Codes Prader-Willi Syndrome  Q87.11 • Prader-Willi syndrome  Q87.19 • Other congenital malformation syndromes predominantly associated with short stature

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FY2020 New Diagnosis Codes Cyclical Vomiting Syndrome  New Code: • R11.15 Cyclical vomiting syndrome unrelated to migraine  Revised code titles: • Subcategory G43.A, Cyclical vomiting, revised with “in migraine” added to codes G43.A0 and G43.A1.

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FY2020 New Diagnosis Codes Pyuria  R82.81 • Pyuria  R82.89 • Other abnormal findings on cytological and histological examination of urine

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FY2020 New Diagnosis Codes Fracture of Orbit  New codes in Subcategory S02.1, Fracture of base of skull • Orbital roof • Right side • Left side, and • Unspecified side  New codes at subcategory S02.8, Fractures of other specified skull and facial bones (specify additional anatomical detail) • Right side, left side and unspecified side • Medial orbital wall • Lateral orbital wall, and • Unspecified

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FY2020 New Diagnosis Codes Multiple Drug Ingestion  New Subcategory • T50.91- for poisoning by, adverse effect of, and underdosing of multiple unspecified drugs, medicaments and biological substances

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FY2020 New Diagnosis Codes Exertional Heat Stroke  T67.01 - Heatstroke and sunstroke  T67.02 - Exertional heatstroke  T67.09 - Other heatstroke and sunstroke 7th Character for initial/subsequent/sequela

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FY2020 New Diagnosis Codes External Cause of Injury Codes for Legal Intervention  New codes in subcategories Y35.0 to Y35.9 • to identify “unspecified person injured.”

 Current codes in these subcategories already provide options including • law enforcement officer injured • bystander injured • suspect injured

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FY2020 New Diagnosis Codes External Cause of Injury Codes for Legal Intervention (cont)  Expanded Subcategory Y35.8, Legal intervention involving other specified means • to identify injuries from legal interventions involving conducted energy device (CED) • Includes electroshock devices (tasers) and stun guns  New codes identify • law enforcement officer injured • bystander injured • or suspect injured

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FY2020 New Diagnosis Codes Z Codes Update: Status Codes  Z22.7 - Latent tuberculosis • Allows differentiating between patients that have been infected with the Mycobacterium tuberculosis bacterium but do not have active tuberculosis (TB) disease  Z96.82 - Presence of neurostimulator • Includes the presence of neurostimulators for different sites (e.g. brain, gastric, peripheral nerve, sacral nerve, spinal cord, or vagus nerve)

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FY2020 New Diagnosis Codes Z Codes Update: Status Codes (cont)  Revised note: Age ranges for adult and pediatric BMI codes in category Z68 • BMI adult codes: persons 20 years of age or older • BMI pediatric codes: persons 2-19 years of age

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FY2020 New Diagnosis Codes Z Codes Update: New Personal History (of) Codes  Z86.002 •

Personal history of in-situ neoplasm of other and unspecified genital organs

•

Personal history of in-situ neoplasm of oral cavity, esophagus and stomach

•

Personal history of in-situ neoplasm of other and unspecified digestive organs

•

Personal history of in-situ neoplasm of middle ear and respiratory system

•

Personal history of melanoma in-situ

•

Personal history of in-situ neoplasm of skin

•

Personal history of latent tuberculosis infection

 Z86.003  Z86.004  Z86.005  Z86.006  Z86.007  Z86.15

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FY2020 New Diagnosis Codes Z Codes Update: New Screening and Counseling Codes  Z11.7 - Encounter for testing for latent tuberculosis infection • Identifies encounters for testing for TB in populations at increased risk

 Z71.84 - Encounter for health counseling related to travel • Identifies encounters where the asymptomatic patients seek travel health counseling services (i.e., health risks) -

Patients present with no signs or symptoms The encounter may be unrelated to a preventive medical care encounter

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FY2020 New Diagnosis Codes Z Codes Update: New Routine and Administrative Examination Codes  Z01.020 • Encounter for examination of eyes and vision following failed vision screening without abnormal findings  Z01.021 • Encounter for examination of eyes and vision following failed vision screening with abnormal findings

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CC/MCC Designations FY2020 Changes

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CC/MCC Designation Overview CC/MCC Status Changes: Majority of proposed CC/MCC changes tabled until FY21 Code Designation MCC CC

FY2020 Additions

FY2020 Deletions

Changes

5

0

+5

75

5

+70

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MCC List Additions/Deletions Additions • I26.93 Single subsegmental pulmonary embolism w/o acute cor • • • •

pulmonale I26.94 Multiple subsegmental pulmonary emboli w/o acute cor pulmonale S02.121BFracture of orbital roof, right side, initial encounter for open fracture S02.122BFracture of orbital roof, left side, initial encounter for open fracture S02.129B Fracture of orbital roof, unspecified side, initial encounter for open fracture

Deletions: NONE

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CC List Deletions D81.3 Adenosine deaminase [ADA] deficiency I48.1 Persistent atrial fibrillation Q79.6Ehlers-Danlos syndrome Q87.1 Congenital malformation syndromes predominantly associated with short stature  T67.0XXA Heatstroke and sunstroke, initial encounter    

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CC List Additions  Adenosine deaminase deficiency  Atrial fibrillation           

•

Persistent/longstanding/chronic/permanent

•

Unspecified/classic/hypermobile/vascular/other)

Phlebitis and thrombophlebitis peroneal vein Acute embolism and thrombosis of peroneal vein Chronic embolism and thrombosis of peroneal vein Ehlers-Danlos syndrome Prader-Willi syndrome Fracture orbital roof, right/left/unspecified, closed/nonunion Fracture medial orbital wall, right/left/unspecified, closed/open/nonunion Fracture lateral orbital wall, right/left/unspecified, closed/open/nonunion Fracture of orbit unspecified, closed/open/nonunion Heatstroke, sunstroke and exertional heatstroke Z16.- Drug Resistance to certain specific antibiotics

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ICD-10-PCS Guidelines FY2020 Revisions, Additions, Deletions

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PCS Guideline Changes Format  Guideline narrative additions appear in bold text  Items underlined were moved within the guidelines since October 1, 2019.  Deletions are shown as strikeouts The complete guidelines may be downloaded from

https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-PCS.html

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“Exceptions� Added To Guidelines [Foreword] . . .

These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-PCS itself. They are intended to provide direction that is applicable in most circumstances. However, there may be unique circumstances where exceptions are applied.

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Guideline B2.1a Revisions The procedure codes in the general anatomical regions body systems Anatomical Regions, General, Anatomical Regions, Upper Extremities and Anatomical Regions, Lower Extremities can be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, Drainage of a body cavity), or on the rare occasion when no information is available to support assignment of a code to a specific body part.

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Guideline B2.1a Revisions (cont.)

Examples: (Some New/Revised/Removed) Control of postoperative hemorrhage is coded to the root operation Control found in the general anatomical regions body systems.

Chest tube drainage of the pleural cavity is coded to the root operation Drainage found in the general anatomical regions body systems body system Anatomical Regions, General.

Suture repair of the abdominal wall is coded to the root operation Repair in the general anatomical regions body system Anatomical Regions, General.

Amputation of the foot is coded to the root operation Detachment in the body system Anatomical Regions, Lower Extremities.

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Guideline 3.1b – Exception Added B3.1b Components of a procedure specified in the root operation definition and or explanation as integral to that root operation are not coded separately. .

Exceptions: Mastectomy followed by breast reconstruction, both resection and replacement of the breast are coded separately.

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Guideline B3.5 Revisions Overlapping body layers B3.5 If the root operations such as Excision, Extraction, Repair or Inspection are performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded

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Guideline B3.9 Revisions Excision for graft B3.9 If an autograft is obtained from a different procedure site in order to complete the objective of the procedure, a separate procedure is coded, except when the seventh character qualifier value in the ICD-10-PCS table fully specifies the site from which the autograft was obtained.

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Guideline B3.9 Revisions (cont.)

Examples: Coronary bypass with excision of saphenous vein graft, excision of saphenous vein is coded separately.

Replacement of breast with autologous deep inferior epigastric artery perforator (DIEP) flap, excision of the DIEP flap is not coded separately. The seventh character qualifier value Deep Inferior Epigastric Artery Perforator Flap in the Replacement table fully specifies the site of the autograft harvest.

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Guideline B4.1b – Example Added B4.1b Examples: …….

A procedure site documented as involving the periosteum is coded to the corresponding bone body part.

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New Guideline: Section D. Radiation Therapy Brachytherapy D1.a Brachytherapy is coded to the modality Brachytherapy in the Radiation Therapy section. When a radioactive brachytherapy source is left in the body at the end of the procedure, it is coded separately to the root operation Insertion with the device value Radioactive Element.

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Section D. Radiation Therapy (cont.)

Example: Brachytherapy with implantation of a low dose rate brachytherapy source left in the body at the end of the procedure is coded to the applicable treatment site in section D, Radiation Therapy, with the modality Brachytherapy, the modality qualifier value Low Dose Rate, and the applicable isotope value and qualifier value. The implantation of the brachytherapy source is coded separately to the device value Radioactive Element in the appropriate Insertion table of the Medical and Surgical section.

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Section D. Radiation Therapy (cont.)

The Radiation Therapy section code identifies the specific modality and isotope of the brachytherapy, and the root operation Insertion code identifies the implantation of the brachytherapy source that remains in the body at the end of the procedure.

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Section D. Radiation Therapy Exception Exception: Implantation of Cesium-131 brachytherapy seeds embedded in a collagen matrix to the treatment site after resection of brain tumor is coded to the root operation Insertion with the device value Radioactive Element, Cesium-131 Collagen Implant.

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Section D. Radiation Therapy Implantation of Cesium-131 Root operation: Insertion Device identifies both implantation and brachytherapy isotope Not included in Radiation Therapy section tables

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Section D. Radiation Therapy (cont.)

A separate procedure to place a temporary applicator for delivering the brachytherapy is coded to the root operation Insertion and the device value Other Device.

Examples: Intrauterine brachytherapy applicator placed as a separate procedure from the brachytherapy procedure is coded to Insertion of Other Device, and the brachytherapy is coded separately using the modality Brachytherapy in the Radiation Therapy section.

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Section D. Radiation Therapy (cont.)

Intrauterine brachytherapy applicator placed concomitantly with delivery of the brachytherapy dose is coded with a single code using the modality Brachytherapy in the Radiation Therapy section.

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Revised Guideline: Section X General E1a Section X codes are standalone codes. They are not supplemental codes. Section X codes fully represent the specific procedure described in the code title, and do not require any additional codes from other sections of ICD-10PCS. When section X contains a code title which fully describes a specific new technology procedure, and it is the only procedure performed, only the that section X code is reported for the procedure. There is no need to report an additional broader, non-specific code in another section of ICD-10-PCS.

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Multiple Procedures Involving Section X Code New Guideline E1.b When multiple procedures are performed, New Technology section X codes are coded following the multiple procedures guideline.

Examples: Dual filter cerebral embolic filtration used during transcatheter aortic valve replacement (TAVR), X2A5312 Cerebral Embolic Filtration, Dual Filter in Innominate Artery and Left Common Carotid Artery, Percutaneous Approach, New Technology Group 2, is coded for the cerebral embolic filtration, along with an ICD-10-PCS code for the TAVR procedure.

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Multiple Procedures Involving Section X Code (cont.)

Magnetically controlled growth rod (MCGR) placed during a spinal fusion procedure, a code from table XNS, Reposition of the Bones is coded for the MCGR, along with an ICD-10-PCS code for the spinal fusion procedure.

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ICD-10-PCS 2020 Update Code Changes

78

Overview of Procedure Code Changes    

734 new codes 2 revised codes 2,056 deleted codes Total number of 2020 ICD-10-PCS codes: • 77,559 codes

Some small changes in • Section 3 - Administration • Section 4 - Measurement and Monitoring • Section 5 - Extracorporeal or Systemic Assistance and Performance • Section 8 - Other Procedures • Section D - Radiation Therapy • Section X - New Technology

79

ICD-10-PCS Changes  Additions are shown as underlined, and deletions are shown as strikeouts in the excerpts from the ICD-10-PCS Tables.  Changes originate from • public comments • CMS internal review • questions submitted to Coding Clinic - discussed by the Editorial Advisory Board for Coding Clinic with recommendations for more specific values

80

New Qualifiers - Bypass Table 001, Central Nervous System and Cranial Nerves, Bypass Body Part

Qualifier

6 Cerebral Ventricle

A Subgaleal Space

Table 021, Heart and Great Vessels, Bypass Body Part

Qualifier

W Thoracic Aorta, Descending X Thoracic Aorta, Ascending/Arch

A Innominate Artery

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New Qualifiers – Bypass (cont.)

Table 031, Upper Arteries, Bypass Body Part

Qualifier

2 3 4 5 6 7 8

W Lower Extremity Vein

Innominate Artery Subclavian Artery, Right Subclavian Artery, Left Axillary Artery, Right Axillary Artery, Left Brachial Artery, Right Brachial Artery, Left

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Coronary Artery Body Part to Root Operation Insertion

Table 02H, Heart and Great Vessels, Insertion

Body Part 0 Coronary Artery, One Artery 1 Coronary Artery, Two Arteries 2 Coronary Artery, Three Arteries 3 Coronary Artery, Four or More

Approach 0 Open 3 Percutaneous 4 Percutaneous Endoscopic

Device

Qualifier

D Intraluminal Device Y Other Device

Z No Qualifier

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Coronary Artery to Root Operation Supplement Table 02U, Heart and Great Vessels, Supplement Body Part

Approach

Device

Qualifier

0 Coronary Artery, One Artery 1 Coronary Artery, Two Arteries 2 Coronary Artery, Three Arteries 3 Coronary Artery, Four or More

0 Open 3 Percutaneous 4 Percutaneous Endoscopic

D Intraluminal Device Y Other Device

Z No Qualifier

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Upper Artery Bypass – Approach Table 031, Upper Arteries, Bypass Body Part

Approach

Device

Qualifier

9 Ulnar Artery, Right A Ulnar Artery, Left B Radial Artery, Right C Radial Artery, Left

3 Percutaneous

Z No device

F Lower Arm Vein

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Deleted Qualifier – Bifurcation Qualifier Bifurcation deleted from the following tables: 037 03C 047 04C 04V

Dilation of Upper Arteries, Extirpation of Upper Arteries, Dilation of Lower Arteries, Extirpation of Lower Arteries, and Restriction of Lower Arteries

Qualifier 6 Bifurcation

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Breast Procedure Code Changes External approach deleted Body Part

Approach

T Breast, Right U Breast, Left V Breast, Bilateral Y Supernumerary Breast

X External

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Breast Procedure Code Changes (cont.)

Tables Affected by deletion of External Approach:       

0H0 Alteration, Skin and Breast 0H5 Destruction, Skin and Breast 0H9 Drainage, Skin and Breast 0HB Excision, Skin and Breast 0HC Extirpation, Skin and Breast 0HD Extraction, Skin and Breast 0HH Insertion, Skin and Breast

0HJ Inspection, Skin and Breast 0HN Release, Skin and Breast 0HP Removal, Skin and Breast 0HQ Repair, Skin and Breast 0HR Replacement, Skin and Breast 0HU Supplement, Skin and Breast 0HW Revision, Skin and Breast

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Breast Procedure Code Changes (cont.)  Distinction between procedures performed on • Skin of chest • Skin of breast  Skin of Chest Procedures • Body Part: Skin, Chest • Approach: X External  Skin of Breast Procedures • Body Part: Skin, Breast • Approach: 0 Open

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Breast Procedure Code Changes (cont.)

Table 0HD, Extraction, Skin and Breast Body Part

Approach Device

T Breast, Right 0 Open U Breast, Left V Breast, Bilateral Y Supernumerary Breast

Z No device

Qualifier

Z No qualifier

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Cell Suspension Epithelial Autograft Qualifier Table 0HR, Skin and Breast, Replacement Qualifier 2 Cell Suspension Technique

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Subcutaneous Implantable Cardioverter Defibrillator Lead – New Device Value Tables affected:  0JH Subcutaneous Tissue and Fascia, Insertion Body Part

Approach

Device

Qualifier

6 Subcutaneous Tissue and Fascia, Chest

0 Open 3 Percutaneous

F Subcutaneous Z No qualifier Defibrillator Lead

 0JP Subcutaneous Tissue and Fascia, Removal  0JW Subcutaneous Tissue and Fascia, Revision Body Part

Approach

Device

Qualifier

T Subcutaneous Tissue and Fascia, Trunk

0 Open 3 Percutaneous

F Subcutaneous Z No qualifier Defibrillator Lead

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Body Part Added: Extirpation of Jaw Table 0WC Anatomical Regions, General Body System, Extirpation Body Part

Approach

Device

Qualifier

4 Upper Jaw 5 Lower Jaw

0 Open 3 Percutaneous 4 Percutaneous Endoscopic

Z No device

Z No qualifier

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Deleted: Clinically Invalid Transfusion Codes Table 302 Circulatory, Transfusion

Body System/Region

Substance

5 Peripheral Artery 6 Central Artery

G Bone Marrow H Whole Blood J Serum Albumin K Frozen Plasma L Fresh Plasma M Plasma Cryoprecipitate N Red Blood Cells P Frozen Red Cells Q White Cells R Platelets S Globulin T Fibrinogen V Antihemophilic Factors W Factor IX X Stem Cells, Cord Blood Y Stem Cells, Hematopoietic 94

Intraoperative ECMO Added Table 5A1, Physiological Systems, Performance Body System

Duration

Function

Qualifier

5 Circulatory

2 Continuous A Intraoperative

2 Oxygenation

F Membrane, Central G Membrane, Peripheral Veno-Arterial H Membrane, Peripheral Veno-venous

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Other Procedure Code Changes  Table 302, New Substance Added • U Stem Cells, T-cell Depleted Hematopoietic  Table 3E0, New Qualifier Added • Hyperthermic antineoplastic chemotherapy - Y Hyperthermic  Table 3E1, New Approach Added • 4 Percutaneous Endoscopic  Section 8, Other Procedures, New Method Added • E Fluorescence Guided Procedure

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New technology New Drugs, Procedures, Devices

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Section X: New Technology  New Code Tables Created: 3  New Tables: • X27, Cardiovascular System, Dilation - Insertion of new Sustained Release DES in peripheral arteries of leg • XXE, Physiological System, Measurement - Whole blood nucleic acid-base microbial detection • XT2, Urinary System, Monitoring - Point-of-care transdermal monitoring of GFR  Qualifier Character 5, New Technology Group 5 • All new codes

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New Therapeutic Substances Table XW0 Anatomical Regions, Introduction 11 new Substance Values Added Device/Substance/Technology J Apalutamide Antineoplastic K Fosfomycin Anti-infective L Erdafitinib Antineoplastic N Meropenem-vaborbactam Anti-infective Q Tagraxofusp-erzs Antineoplastic R Venetoclax Antineoplastic S Iobenguane I-131Antineoplastic T Ruxolitinib U Imipenem-cilastatin-relebactam Anti-infective V Gilteritinib Antineoplastic W Caplacizumab

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Other FY2020 Changes  Medicare Code Edit updates  Additions to Unacceptable Principal Diagnosis list  DRG Grouping changes • Surgical hierarchy changes • Titles revised • DRGs deleted • Codes grouping to different DRGs Find all the details at: https://www.cms.gov/Medicare/Medicare-Fee-for-

Service-Payment/AcuteInpatientPPS/FY2020-IPPS-Final-Rule-Home-PageItems/FY2020-IPPS-Final-RuleTables.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

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ICD-11 Update from AHIMA19 Conference Adopted by the World Health Assembly in May 2019  Fully electronic; can be well integrated with electronic health applications and information systems  No plans for ICD-12  ICD-11 has been built in such a way that it can be expanded without having to develop a new version  World Health Organization believes migration will be less expensive due to automation and development of new tools • Coding tools • Browsing tools • Mapping tool 101

ICD-11 Update from AHIMA19 Conference US Transition to ICD-11  National Committee on Vital and Health Statistics (NCVHS) has begun to evaluate pathways to US transition  Foster early stakeholder engagement and industry communications  Develop a series of recommendations for the HHS Secretary  NCVHS convened a roundtable of terminology experts, economists, and health researchers to reach consensus on the research questions on cost and benefit of the transition from ICD-10 to ICD-11 and key communication messages  NCVHS plans to send recommendations to HHS Secretary later this year

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ICD-11 Expert Roundtable Key discussion themes:  Lessons learned from ICD-10 transition?

• hopefully lead to a smoother transition  US healthcare industry is different now after when ICD-10-CM/PCS • ICD-11 should be implemented before we lose knowledge gained during the ICD-10 transition  US clinical modification may not be needed with ICD-11

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ICD-11 Expert Roundtable Key discussion themes (cont.):  ICD-10-PCS is separate • does not need to be updated in conjunction with the transition to ICD-11  Feasibility of different time frames for transitioning to ICD-11 should be evaluated (2025?, 2027?, 2030?)

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ICD-11 Further Information

For further information on ICD-11 and to see the code set visit: https://icd.who.int/en/

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WHEW!

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References  National Center for Health Statistics (2019). 2020 ICD-10-CM. https://www.cdc.gov/nchs/icd/icd10cm.htm  Centers for Medicare and Medicaid Services. (2019). 2020 ICD-10PCS. https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10PCS.html  Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2020 Rates, 84 Fed. Reg. 42044 (Aug. 16, 2019). https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/FY2020-IPPS-Final-Rule-HomePage.html  World Health Organization. ICD-11. https://icd.who.int/en/

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Questions?

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Thank You

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