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June 30, 2015

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Medical Coding News


Fifty New PCS Codes Added for 2016 in Spite of Code Freeze

June 30, 2015

Despite the partial code freeze imposed on the ICD-10 code set, 50 new ICD-10-PCS codes have been announced, to be effective along with the rest of the code set October 1, 2015. ICD-10 has been under a partial code freeze for two years, allowing only minimal changes to reflect new technology and advancements. There are no revised or deleted codes.

Thirty-six of the new codes describe the dilation of femoral and popliteal arteries using a drug-coated balloon (all begin with 047), and 14 were added to the new X code section for new technology. A list of the new codes, along with their descriptions, are at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-New-Procedure-Codes.pdf.

Also released with the new codes were the general equivalence mappings (GEMs), as well as the addenda, which are usually released separately from the code set. GEMs provide a kind of crosswalk between ICD-9 and ICD-10 procedure codes, although there is not a one-to-one correspondence between the two systems since ICD-10-PCS has so many more codes than does ICD-9-CM. The addenda provide only those changes made to the PCS index, definitions of terms used in the ICD-10-PCS code set, and tables used to build codes.

The new X code section maintains continuity with the rest of the code system by keeping the same root operation and body part values as similar codes in other sections. No new coding guidelines or unfamiliar coding concepts arise because of the X codes. CMS created the new section because public comment did not support adding new technology codes to current sections of ICD-10-PCS.

CMS stresses that X codes are not supplemental codes, but are stand-alone. When an X code is listed, there is no need to report another, broader code from another section of the code system. As an example, CMS offers code XW04321 Ceftazidime-Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1. When it is reported, there is no need to also list a code from table 3E0 to describe the administration of the ceftazidime-avibactam.

All new-technology codes will be listed in the alphabetic index under the main term “New Technology,” as well as under the name of the new device, substance, or technology.



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