Changes to ICD-10-PCS Codes: CMS Updates Effective October 2022

The Centers for Medicare & Medicaid Services (CMS) has released the fiscal year (FY) 2023 updates to the ICD-10-PCS codes. ICD-10-PCS is a procedure classification system CMS developed for procedure codes that track various health interventions made by medical professionals.

The FY 2023 updates include 64 deleted codes, 331 new procedure codes, and no revisions. This brings the total of ICD-10-PCS codes to 78,496. The updates are effective beginning October 1, 2022.

FY 2023 ICD-10-PCS Deletions

The majority of the deleted codes comprise laser interstitial thermal therapy procedures, which CMS has moved from the Radiation Therapy PCS table to the Destruction (eradication of all or a portion of a body part) PCS tables and expanded.

Another large portion of the deletions occurs in the new technology section. CMS is deleting new technology codes including the following:

• Joint fusions using a nanotextured surface interbody or a radiolucent porous interbody fusion device: CMS has moved these procedures from the New Technology Joint Fusion PCS table to the Medical and Surgical Upper Joint Fusion PCS table.
• Extracorporeal supersaturated oxygenation (intermittent and continuous): This new duration value in the Extracorporeal or Systemic Assistance and Performance Physiological Systems Assistance PCS table identifies cardiac perfusion with intra-arterial supersaturated oxygen.
• Replacement of aortic valves using the rapid deployment technique: These procedures have moved from the New Technology Cardiovascular System Replacement PCS table to the Medical and Surgical Heart and Great Vessels Replacement PCS table.
• Replacement of skin using a porcine liver-derived skin substitute: CMS has moved these procedures from the New Technology Skin, Subcutaneous Tissue, Fascia and Breast Replacement PCS table to the Medical and Surgical Skin and Breast Replacement PCS table.
• The introduction of bone marrow into the muscle: These procedures have moved from the New Technology Muscles, Tendons, Bursae and Ligaments Introduction PCS table to the Administration Physiological Systems and Anatomical Regions Introduction PCS table
• The introduction of certain anticoagulants and monoclonal antibodies: CMS has moved these procedures from the Administration Physiological Systems and Anatomical Regions Introduction PCS table to the New Technology Anatomical Regions Introduction PCS table to further specify the type of substance being introduced.

New ICD-10-PCS Codes for FY 2023

Below are highlights of some of the new codes categorized by PCS table:

Medical and Surgical Section

Central Nervous System and Cranial Nerves: This section has 15 new codes, including destruction of the brain and spinal cord using laser interstitial thermal therapy and extraction of the cerebellum.

Heart and Great Valves: There are three new codes in this section that describe the replacement of the aortic valve with zooplastic tissue (graft from human to animal) using the rapid deployment technique.

Lower Arteries: The 18 new codes in the lower artery section describe the occlusion of the left or right prostatic arteries through various approaches.

Respiratory System: There are 27 new codes in the respiratory system section for destruction of specific parts of the lungs using laser interstitial thermal therapy.

Gastrointestinal System: CMS has added 79 codes to this section. The additions include destruction of the esophagus, esophagogastric junction, stomach, small intestine, duodenum, jejunum, ileum, ileocecal valve, large intestine, cecum, appendix, colon, rectum, and anus. Also included are codes describing the transfer of the small or large intestine to the bladder or ureters.

Hepatobiliary System and Pancreas: There are 39 new codes in this section to describe the destruction using laser interstitial thermal therapy of the liver, gallbladder, hepatic, cystic, and common bile ducts, as well as the ampulla, pancreatic ducts, and pancreas.

Endocrine System: There are 66 new codes in the endocrine system section to describe the destruction using laser interstitial thermal therapy of the pituitary gland, adrenal glands, carotid bodies, para-aortic body, coccygeal glomus, glomus jugulare, aortic body, paraganglion extremity, thyroid glands, and parathyroid glands.

Skin and Breast: Six new codes in this section cover the destruction of the breast using laser interstitial thermal therapy.

Head and Facial Bones: There are eight new codes in this section describing the removal or revision of an infusion device in the skull.

Male Reproductive System: Three new codes in this section describe the destruction of the prostate using laser interstitial thermal therapy.

General Anatomical Regions: Six new codes in this section describe the drainage of the neck, either with or without a drainage device.

The Administration Section

Physiological Systems and Anatomical Regions: Four new codes in this section describe the introduction of monoclonal antibodies and other therapeutic substances into the veins and bones.

Extracorporeal or Systemic Assistance and Performance

Physiological Systems: One addition to the physiological systems section describes assistance with cardiac supersaturated oxygenation.

Imaging

Respiratory System: There is one new code in this section to describe the magnetic resonance imaging (MRI) of the lungs using the hyperpolarized xenon 129 (Xe-129).

New Technology

The remaining 55 new codes are within the New Technology section. CMS created a large portion of the new codes to report the introduction or transfusion of various anti-infectives, antineoplastics, immunotherapies, and cell therapies. Several new codes describe joint procedures, such as insertion or fusion of joints using internal fixation or spinal motion preservation devices and replacement of knee joints using synthetic substitutes. Two additional new codes cover the supplementation of spine bursa and ligament with a posterior vertebral tether.

Another group of additions to the new technology section is for the destruction of the liver tissue using ultrasound-guided cavitation. CMS created several more additions regarding measurement that include measurement of the following:

• Brain electrical activity using computer-aided semiologic analysis.
• Coronary artery flow using quantitative flow ratio analysis or computer-aided valve modeling and notification.
• Infection using whole blood reverse transcription and quantitative real-time polymerase chain reaction.

Other additions include the insertion of neurostimulator leads (sometimes paired with a stimulation system) into the nerves of the brain, computer-assisted transcranial magnetic stimulation of the prefrontal cortex, and intermittent coronary sinus occlusion.

CMS will publish these codes in the 2023 ICD-10-PCS codebook, but they’re available for review now within Vitalware® by Health Catalyst products.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

• New CPT Codes for 2022: This Year’s Need-to-Know Updates
• 2022 Healthcare Reimbursement Changes Reinstating Significant Inpatient Coverage
• ICD-10 PCS: Harnessing the Power of Procedure Codes
• Surprise Billing in Healthcare: The No Surprises Act Takes a Stand for Patients
• Healthcare Financial Recovery: A Guide to the COVID-19 Add-On Payment