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General Guideline Updates 2017

Current Update: B4.1a: If a procedure is performed on a portion of a body part that does not have a separate body part value, code the body part value corresponding to the whole body part.

B4.1b If the prefix “peri” is combined with a body part to identify the site of the procedure, the procedure is coded to the body part named.

Added New: Totally Tubular New Guideline B4.1c:

(Under B4, Body Part General Guidelines) clarifies coding procedures on tubular structures:

If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the furthest anatomical site from the point of entry.

Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part.

Current Update: Discontinued Procedures B3.3.  If the intended procedure is discontinued, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation was performed, code the root operation for Inspection of the body part or anatomical region inspected.

Revised Update: Completed Incomplete Procedure Guideline B3.3

The wording for B3.3 will see some changes in the header and first sentence.

Discontinued or incomplete proceduresB3.3.  If the intended procedure is discontinued or otherwise not completed, code the procedure to the root operation performed.

Root Operation Over Control Clarified in B3.7:

Guideline B3.7 about Control will change the specified list of definitive root operations to a list of examples.

Current update: 2017: If an attempt to stop post procedural or other acute bleeding is initially unsuccessful, and to stop the bleeding  requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.

Revised Update: 2018: If an attempt to stop post procedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then the more definitive root operation is coded instead of Control.

Temporary Device at Center of B6.1a:

Current update:  A device is coded only if a device remains after the procedure is completed.  If no device remains, the device value No Device is coded.

Revised Update:  A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. In limited root operations, the classification provides the qualifier values Temporary and Intraoperative, for specific procedures involving clinically significant devices, where the purpose of the device is to be utilized for a brief duration during the procedure or current inpatient stay.


Coding Updates for ICD-10-PCS

It’s only June of 2017, but for coders that means it’s time to start watching for 2018 updates.

ICD-10-PCS files are already available for review. This inpatient coding system, which changes to the 2018 version on Oct. 1, 2017, there are

  • 3,562 new codes
  • 646 deletions for a total of 78,705 codes in the next version.
  • And 1,821 revisions.

Here are some highlights:

Revisions for clarity and usefulness in the Medical and Surgical section:

Medical and Surgical: As you review the definitions addenda file, watch for deletions that have a related addition.

Example: For Section 0 (Medical and Surgical), Character 4 (Body Part), you’ll see “Delete” next to the ICD-10-PCS value Nose. But before you start wondering how you’ll report nose procedures, scroll down a bit to find the added value Nasal Mucosa and Soft Tissue. The terms in the definition for both values are the same.

Addition of endoscopic approaches to various tables:

Tables: The table’s addenda file is more than 400 pages, so homing in on the changes specific to what you code will be important for manageable 2018 preparation.

Example: If you report procedures on the coronary arteries, check out the changes to the table for 3E0 with fourth character 7. You’ll see a new fifth character option 4 for Percutaneous Endoscopic.


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Molecular Pathology Procedure Effective From July 2017

81400 – Molecular pathology procedure, Level 1 (eg, identification of single germ line variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis)

81401 – Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant [typically using non sequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat)


Coding Update 90587, 90620, 90621,…

90587 – Dengue is a mosquito-borne illness typically associated with tropical and subtropical areas. Patients suffer from high fever, rash, and muscle and joint pain that have earned the disease the descriptive nickname “break bone fever.” Treatment is often limited to hydration and pain medication.

90620 – MenB-4C is the complete scientific abbreviation assigned by the Advisory Committee on Immunization Practices (ACIP). The CPT vaccine code descriptors in the May 2014 meetings.

90621 – Also note the reference to the “2 or 3 dose schedule,” which differs from the reference to only a three-dose schedule in the 90621 descriptor published in the 2017 printed manual. Meningococcal diseases can affect the brain and spinal cord, and cause bloodstream infections. Antibiotics can treat infected patients.

90651 – Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 3 dose schedule, for intramuscular use.


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