The ICD-10 thaw, part 2: The FY 2018 ICD-10-PCS update

The ICD-10-PCS FY 2018 update was posted on the CMS website in the second half of May, and contains the changes to PCS that go into effect on October 1. You can download all of the update files and see the details for yourself, or just get a high level view from a PDF titled 2018 Version Update Summary, from the CMS website.

This year’s update is significant because it marks the end of playing catch up. This is the second and final update year that includes a backlog of changes accumulated during the partial code freeze. The partial code freeze refers to the four-year period just before ICD-10 implementation in 2015, when nothing but essential new technology procedure codes were allowed to be added to the system. From now on, any single update year only contains one year’s worth of changes. I am very glad to see the end of the catch-up years, and I’ll bet I’m not the only one. It has been a bit of a slog.

Normally, the changes in an update year come from one year’s worth of meetings of the ICD-10 Coordination & Maintenance (C&M) Committee, and the changes for a given update cycle include proposals from September of the previous year and March of the current year. There are two basic types of C&M Agenda Items: 1) proposals, which are formal written requests, typically developed by an organization requesting additions to the ICD-10-PCS classification; 2) addenda, which are individual public requests sent by email to CMS, or recommendations coming from the Cooperating Parties in concert with the Coding Clinic Editorial Advisory Board.

During the code freeze, C&M meetings were held as usual. Lots and lots of proposals and addenda were presented during the four years of the code freeze, and only a few proposals for New Technology PCS codes were added during the freeze. So that meant all other proposed code updates that received favorable public comment during the comment period were put in the deep freeze, to be implemented after the code freeze ended.

Since Implementation, the code freeze backlog and other proposed changes have been implemented during the FY 2017 and FY 2018 updates. CMS chose a phased approach to implementing the backlog of changes accumulated during the code freeze, because organizations expressed concern that making all of the changes in the first update after implementation would be overwhelming. So this is how the phased approach worked:

First update year—proposals presented during the code freeze and receiving public support

Second update year—addenda items collected during the code freeze, presented after the code freeze at the last two C&M meetings, and receiving public support

Last year’s update to ICD-10-PCS (FY 2017) included proposals presented during the code freeze and receiving public support. Here are a few examples:

• A new root operation called “Perfusion” was created to classify procedures performed on marginal donor organs prior to transplant
• The thoracic aorta body part value was split into two more specific body part values in the PCS tables, one for the ascending/arch portion of the thoracic aorta and the other for the descending portion of the thoracic aorta
• Multiple new device values were created that specify the number of vascular stents put in during a single procedure, such as a coronary angioplasty (PTCA)
• The qualifier specifying that a procedure was performed at a vessel bifurcation (where a vessel branches off) was applied to many more PCS tables

This latest update to ICD-10-PCS (FY 2018) contains addenda items collected during the code freeze, presented at the September 2016 and March 2017 C&M meetings, and receiving public support. Here are some examples from the code freeze backlog:

• The root operation Extraction was applied to new body systems, to specify fine needle aspiration biopsies, and to other body systems, to specify non-excisional debridement of deep tissue layers, such as muscle and tendon
• A new body part value was added to uniquely identify procedures performed on the common hepatic duct (before the duct branches into the left or right hepatic duct)
• The endoscopic approach value was added to many more PCS tables

The FY 2018 ICD-10-PCS update also contains new proposals for changes, which were presented during the September 2016 and March 2017 C&M meetings.

Here are some examples:

• A new code for the REBOA procedure (Resuscitative Endovascular Balloon Occlusion of Aorta)
• A new qualifier value in the Administration section to uniquely identify administration of the influenza vaccine
• A new device value for oxidized zirconium hip implant, used in hip replacement procedures
• A new qualifier value for procedures performed specifically on the sesamoid bones of the foot

In an ideal world, all of these “old” changes—known issues that needed to be fixed in addition to catch-up stuff—would have been taken care of before implementation, and the industry wouldn’t have to go through the tedious job of updating all of the downstream systems in use. But, as I’m sure I need not remind you, an ideal world is not where we live. So here we are.

And that, my friends, is good news. Here we are! We made it through the thaw! The PCS iceberg was not the size of Delaware, like the one that just broke off of Antarctica, but it was not nothing. Future updates should be a lot less painful.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.