Another one bites the dust: The ICD-10-PCS FY 2023 update

It happens every year around Memorial Day: The ICD-10 procedure code updates are posted on the  Centers for Medicare & Medicaid (CMS) website just as people are thinking summer thoughts. Someone sends the first email announcing their vacation plans and as more people pile on to the email thread, the summer calendar starts to resemble Swiss cheese.

For coders and other “consumers” of the ICD-10 procedure code set, there is plenty of time to bone up on the changes between now and October 1, when the new codes go into effect. But for educators and producers of coding software and references, the work is just starting, and deadlines are tight. People are scrambling to update their content so users will have everything they need for October 1.

For me, happily, the work has just ended. Because I work under 3M’s contract with CMS to assist with producing the ICD-10-PCS update, I am already in that satisfying tired state that comes after deadlines are met and a project is complete. In that state, because by nature I am a “big picture” sort of person, I can’t help but look back at that chunk of work and assess what we did. So, here are a few general observations on the procedure code updates for this year.

The NTAP tail still wags the dog

Of the 29 agenda topics included in the March C&M meeting, 22 proposals were for new codes to support CMS’ New Technology Add-on Payment (NTAP) policy. Of those 22 proposals for new codes, 15 were for administration of drugs, lab tests, or for diagnostic software that uses machine learning techniques to analyze images or other data. None of these procedures would, under normal circumstances, be coded on an inpatient record.

The other seven NTAP proposals were for specialized adaptations of familiar devices, such as using neurostimulators to treat residual effects of stroke or new devices/techniques for joint fusion or spinal fixation. In other words, a generous majority of changes to the procedure code set continue to be explicitly for payment purposes. For a full-sized rant on this subject, you can see the blog I posted last year around this time.

Less is more

With a few exceptions like spine procedures, the trend in new codes is increasingly about minimally invasive techniques for treating disease, or for therapies that use genetically modified or otherwise highly processed human cells. This year’s update contains new codes for Laser Interstitial Thermal Therapy (LITT), a technique that uses laser heat via a thin probe inserted through the skin (or a small hole drilled through the skull) to destroy tumors in many parts of the body. A completely external technique with no incisions or punctures at all, called ultrasound-guided cavitation, is also used to destroy tumors, in this case specifically for the liver.

New codes have been added for more types of therapies using genetically modified stem cells. There is also a new code for human donor thymus tissue that has been highly processed so that donor matching is not an issue. It is for implantation in pediatric patients born without a thymus and who therefore have life-threatening immunodeficiency.

It’s the principle of the thing

In this age where we let Google, social networks and the artificial intelligence in our mobile phones organize and prioritize our information for us, it is more noticeable that people in the coding community are still very hands-on when it comes to classifying procedures. Given that coding is becoming increasingly automated, people could easily say, “Who cares where we put stuff, the algorithm will find it.” But they don’t. I should say “we don’t”—I can be as opinionated as anyone when trying to decide whether a procedure “belongs” in one ICD-10-PCS table vs. another.

The LITT procedure code proposal is a classic example of this. We already had LITT codes in ICD-10-PCS, added a few years ago to one of the ancillary sections. But the doctors who perform the procedure and the manufacturers who make the equipment felt strongly that the procedure should be in the med/surg section rather than an ancillary section.

The coding community unanimously agreed. So, for this update all of the LITT codes were “moved”—222 LITT codes were added to the med/surg section, 31 LITT codes were deleted from the ancillary section where they were previously classified, and 342 entries were added to the ICD-10-PCS conversion table to track data coded before and after the changes.

That’s a lot of changes to accommodate people’s need for something to make sense to them. It would be wonderful if other things that don’t make sense (war and racism come to mind) were so easily fixed.

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