geal Vein. In table 0D1, Gastrointestinal Bypass, a new row has
been created for the general body part value Small Intestine,
which will allow for coding of Bypass procedures when the specific segment of the small intestine cannot be determined. Because a patient’s normal gastrointestinal anatomy can change
when they have procedures done, it may become difficult for a
surgeon to identify the specific segment of the intestine, so having the general term Small Intestine will provide better data accuracy. The same concept applies with the addition of the new
row for the general body part value of Large Intestine. One example of when this value might be used is when a colostomy is
performed on a patient with a previous colon resection. In addition, a new row has been added to the Transfer table 0DX to capture the use of the large intestine as a means of creating a vagina.
One of the biggest FY 2020 changes for ICD-10-PCS is regarding procedures performed on the breast and the skin that covers the breast. Mammary tissue makes up the contents of the
breast, and that tissue lies below the skin. For this reason, the
approach value External has been removed from multiple rows
in multiple tables in the Skin and Breast body system. In the Replacement table for Skin and Breast, External Approach, we see
that the device value for Nonautologous Tissue Substitute has
been placed on a separate row with the exact same body parts,
so that the new qualifier value for Cell Suspension Technique
could be added for Autologous Tissue Substitute. Cell suspension requires harvesting of a small split-thickness skin sample
from the patient, which is then put through a process where the
epidermis is separated from the dermis and a mix of several cell
types are then suspended in a solution that can ultimately be
sprayed or dropped on the prepared graft recipient site. This solution will eventually become a permanent layer of the patient’s
own skin without the use of any fixators, such as sutures.
In the Subcutaneous Tissue and Fascia body system, the new
device value Subcutaneous Defibrillator Lead has been added to
the Subcutaneous Tissue and Fascia, Chest body part in the In-
sertion table. If we insert a device, we have to be able to Remove
and Revise it as well, so in table 0JP, the device value for Subcuta-
neous Defibrillator Lead has been added for the body part value
of Trunk rather than creating a new row for Chest. This aligns
with the Cardiac Rhythm Related Device value in this table.
For the insertion of a device into the Upper Bones body part val-
ues for the humeral shaft, left and right have been separated onto
a new row, adding the new device value Internal Fixation Device,
Intramedullary Limb Lengthening. This new value distinguishes
this device from the Intramedullary Fixation Device. This same
addition was applied to a newly created row in the Lower Bones
for body part values of right and left femoral shaft and tibia.
The final update in the Medical and Surgical section is in the
table 0WC, Extirpation, Anatomical Regions General. A new
row has been added that provides body part values for upper
and lower jaw, allowing for evacuation of a hematoma or re-
moval of a foreign body from the mandibular and/or maxillary
While this is a high-level review of some of the major changes in the Medical and Surgical section, complete review of all
updates to the tables, resources, and guidelines is best practice for all coding professionals. ¢
Maria N. Ward ( firstname.lastname@example.org) is a director of HIM practice
excellence at AHIMA.
Quiz ID: Q1939010 | EXPIRATION DATE: NOVEMBER 1, 2020
HIM Domain Area: Clinical Data Management
Article—“Fewer Codes for 2020 in ICD-10-PCS”
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