EVERY YEAR AS the summer months arrive, coding profes- sionals, healthcare providers, documentation improvement specialists, and other healthcare professionals wait expec- tantly for the release of all the Centers for Medicare and Med- icaid Services (CMS) coding updates. This year is no different. May 2017 brought with it the usual graduation ceremonies and start of summer vacation, but also the highly anticipated release of the fiscal year 2018 ICD-10-PCS updates. So what does fiscal year 2018 have in store for coding professionals? Let’s take a look. Compared to the great release of fiscal year 2017, the fiscal year 2018 release is not quite as overwhelming. In total, there
are 3,562 new codes, 1,821 revised titles, and 646 deleted codes.
There were also a few guideline changes, so let’s start with those.
Fiscal Year 2018 Guideline Changes
The first change is in guideline B3.3. The title of the guide-
line was revised from Discontinued procedures to Discon-
tinued or incomplete procedures. The first sentence has
been changed to read, “If the intended procedure is discon-
tinued or otherwise not completed, code the procedure to
the root operation performed.” While an example was not
added to demonstrate a root operation other than inspec-
tion, one example that would apply is an attempted throm-
bectomy that was performed, but the thrombus did not
clear with the first attempt and the procedure was ended
without a second attempt to clear the thrombus because the
patient became restless. This example would be coded as an
Extirpation because the root operation was completed, but
Also revised was guideline B3.7 in order to clarify the use
of Control versus a more definitive root operation. It states:
“If an attempt to stop postprocedural 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.” This revision allows for
the use of other root operations besides the seven listed in
the guideline. An example would be a patient with epistaxis
with nasal packing. A more definitive root operation would
be Packing rather than Control.
A new guideline added is B4.1c, which states, “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.” The example provided does not give a specific root operation, but does provide that a procedure performed on a continuous section of
artery that begins in the femoral and extends to the external
iliac is coded to the body part for external iliac.
Guideline B6.1a has been expanded to address a new qualifier that has been added to a few root operations. The new
qualifier value is for Temporary, and has been added to address clinically significant devices that are only left in place
for a brief time during a procedure or current inpatient stay.
The new codes 02LW3DJ, Occlusion of Thoracic Aorta, Descending with Intraluminal Device, Temporary, Percutaneous Approach, and 04L03DJ, Occlusion of Abdominal Aorta
Fiscal Year 2018 Updates to
By Maria N. Ward, MEd, RHIT, CCS, CCS-P