10 ICD-10-PCS Coding Questions to Test Your Skills

Take this quiz to identify where you need to focus your learning.

Think you have nailed down ICD-10-PCS code changes effective Oct. 1, 2018? Have you studied the ICD-10-PCS coding guidelines while familiarizing yourself with the 2019 code changes?

For several months now, you’ve been reporting 2019 PCS codes, and your success rate probably grows with each claim. Let’s test your knowledge of 2019 ICD-10-PCS codes, guidelines, tables, and device characters to ensure your coding continues to stay on track throughout the rest of the year.

Question 1: How many ICD-10-PCS code changes went into effect on Oct. 1, 2018?

Answer: There aren’t many ICD-10-PCS code changes effective Oct. 1, 2018. In all, you’ll find 392 new and eight revised codes in your 2019 ICD-10-PCS code book. You’ll also no longer notice that 216 codes were deleted from the code set.

Question 2: A new guideline was added to the Root Operations—B3.17 Transfer procedures using multiple tissue layers. Why was this new guideline introduced?

Answer: The new guideline was introduced to clarify coding of a transfer flap when there is more than one tissue layer involved.

For procedures involving transfer of multiple tissue layers (including   skin, subcutaneous tissue, fascia or muscle), the procedure is reported to the body value that describes the deepest tissue layer in the flap, and the qualifier can be used to describe the other tissue layer or layers in the transfer flap.

Question 3: The guideline A10 has been revised. What is the change that you need to know?

Answer: The guideline A10 has been revised to explain that “and” means “and/or,” excluding when the word “and” is found in a qualifier (for instance the qualifier option for a muscle flap transfer from table 0KX during a mastectomy).

Question 4: The ICD-10-PCS guideline B3.7 has also been revised. What’s different in the 2019 code set?

Answer: The guideline B3.7 has been revised to strike off the word ‘initially’ to indicate the definitive procedure can be used at any time to stop the bleeding. This clarifies the previous mix-up on whether a control method must be used first before a definitive procedure can be reported.

Question 5: You’ll find new control codes related to nasal tissue in 2019 ICD-10-PCS. What are they?

Answer: The 2019 ICD-10-PCS code set has added new control codes related to nasal tissue. The new codes are: 093K7ZZ and 093K8ZZ. Note that the second code is endoscopic.

Question 6: How many new PCS Tables were added for 2019? And what are they?

Answer: For FY 2019, four new ICD-10-PCS Tables were added, including Table 093, Table 0FD, Table 0VX, and Table XV5.

Question 7: What do you need to know about the new Table 093 Control Bleeding Ear, Nose, Sinus?

Answer: The introduction of the new Table 093 is interesting to note. The Table is a new guideline to describe control of epistaxis from the nasal mucosa or soft tissue on the inside of the nose. This change is noteworthy as it represents a change in the guideline explanation of control as being reported only within an anatomical region of the body as against a specific body part.

Question 8: Are there new and revised device characters applicable to the knee joints established for FY 2019? What was the purpose?

Answer: Yes, there are new and revised characters pertaining to knee joints that have been established to help capture of additional detail for knee arthroplasty procedures. You can find these device characters under the root operation Replacement and Removal.

Question 9: Which 2019 ICD-10-PCS change will help in the proper classification of cesarean delivery procedures?

Answer: Effective Oct. 1, the qualifiers to describe the location of the incision during a cesarean delivery on Table 10D have been changed. This update will help in the correct classification of cesarean delivery procedures.

Question 10: How many new codes were added in the New Technology section in 2019 ICD-10-PCS?

Answer: Five new codes were added in the New Technology section, including one new Table (XV5) and a couple of new rows in the already existing Table XW0.

Note: Coders often make the mistake of overlooking new technology codes. It’s important that you and your team familiarize yourselves with the new technologies each year.

Bottom-Line: There’s no reason to feel overwhelmed when it comes to ICD-10-PCS coding. If you understand the ICD-10-PCS guidelines and refer to reliable ICD-10 coding resources, you’ll find accurate code assignment easier than you might have expected.

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Four FAQs Help Guide Your 2019 CPT® And ICD-10 Reporting – TCI

Keep your medical coding books handy.

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Physician practices have been using the new CPT® and ICD-10 codes for a while now, and many have struggled with the best ways to incorporate them into their practice. In this article we cover some frequently-asked questions (FAQs) relating to 2019 code changes along with answers that can guide your reporting:

Question 1: Our gastroenterologist removed a PEG tube for a patient in the office and did not replace it. We are not sure which code to use here. Should we use the new code 43762?

Answer: No, in this situation, you cannot use the 2019 code 43762 as this code only applies if the gastroenterologist removed the PEG tube and then placed another one. In its place, the best bet for a PEG tube removal in the office is to report the proper outpatient E/M code — 99201–99215 — which you should choose based on the physician’s documentation.

Question 2: How should we report ulcerative blepharitis of the left upper eyelid following the overhaul of blepharitis codes?

Answer: As you know, new codes in 2019 ICD-10 coding books expanded the blepharitis codes to allow you a way to report additional eyelids, when affected. But that does not mean there are new codes for every blepharitis condition.

If the patient has ulcerative blepharitis of the left upper eyelid, you’ll report H01.014 (Ulcerative blepharitis, left upper eyelid). Here you’ll report it the same way as you reported in 2018.

What’s different though is that in the 2019 new code set, you can report just one code when more than one eyelid is affected with blepharitis, contrary to the old way, which requires you to bill multiple codes when you treat multiple eyelids. The new codes include: H01.00A, H01.00B, H01.01A, H01.01B, H01.02A, and H01.02B.

So, make sure you report blepharitis using the “business as usual” approach unless multiple eyelids are affected.

Question 3: Which of the two new ERG codes — 92273 or 92274 — apply to pattern ERG?

Answer: Sadly, neither of these CPT® codes — 92273 or 92274 — represents the right way to report pattern ERG. The fact is CPT® 2019 introduced not two but three codes, and one of them is a Category III code — 0509T— Electroretinography (ERG) with interpretation and report, pattern (PERG). And, that’s why you may have overlooked it.

For your scenario, the appropriate code would be 0509T as your physician performed a pattern ERG. Look up the introductory note to the section of CPT® where these codes are listed …If the technique used is not specifically named in the descriptors of codes 92273, 92274, or 0509T, go for the unlisted code 92499.

Thus, all of your ERG services will not always fit into one of the three codes mentioned above. In some cases, your best bet will be 92499. That’s why it’s very important to read the documentation carefully to confirm the ERG type prior to selecting the correct code.

Question 4: What’s the difference between the new elastography codes for 2019–76981 and 76892?

Answer: CPT® 2019 deleted the temporary ultrasound elastography code +0346T and replaced it with a couple of new codes — 76981 and 76982. The difference between the two procedures depends on the type of tissue being examined. So, for example, if you are performing a US elastography procedure on diseased liver tissue, you will select 76981 as the provider is imaging an organ. On the contrary, if the provider performs a US elastography on diseased tissue not affecting a particular internal organ, you would use the code 76982.

Have More Questions? Here’s a Simple Solution

Are you still facing challenges about which of the 2019 codes to use or how the revisions or deletions impact your procedure and diagnosis coding? Even though it’s a costly annual expense, bottom-line is you really should have new versions of CPT®, ICD-10 and HCPCS medical coding books each year.

Best bet: Get TCI’s 2019 medical coding book bundles — and save on your ICD-10, CPT®, and HCPCS resources (including AMA coding books)! You’ll nail down 2019 diagnostic and procedure code changes and get all the details you’ll need for accurate reporting without spending much.

View Source: Check Out These FAQs to Keep Your 2019 Claims in Tip-Top Shape

Stay on Top of These ICD-10 Updates to Keep Your Reporting on Track in 2019

It’s that time of year again! As you prepare to flip the calendar to 2019, don’t forget to take some time to look back and review key 2018 ICD-10 updates, as these will factor significantly into your coding, compliance, and reimbursement for the coming year.

ICD-10-Updates-2019-TCI

  • CMS Released Nearly 500 ICD-10-CM Code Changes for 2019

This summer, CMS released 470 + changes to the 2019 ICD-10-CM code set — including 279 new, 143 revised and 51 deleted ICD-10 codes. These ICD-10-CM codes will be used for discharges and patient encounters occurring from Oct. 1, 2018 through Sep. 30, 2019.

  • GEMs Files Take the Exit in 2019

The GEMs files have seen their day and will no longer be used. This is a blow for those medical coders who have been looking forward to checking the 2019 GEMs files. CMS announced the expiry of the GEMs file in the fiscal year 2019 IPP final rule, as it did not see the need for the files after the transition. Many organizations, however, will still offer the 2018 set for those looking to find the links between both ICD-9 and ICD-10 code sets.

  • 2019 ICD-10 Update & the MIPS Quality Measures Impacted

The CMS has identified four quality measures affected by the Oct. 1 ICD-10-CM updates. The measures affected are registry measures stewarded by the American Academy of Dermatology. Providers submitting performance data under the MIPS should limit data collection to the first nine months (from January 1 to October 1) of the performance period for these quality measures. Get more details here.

  • Q4 2018 Coding Clinic Addressed Infamous Excludes1 Dilemma for Good

Coding Excludes1 notes have been a controversial topic among hospitals and medical practices, largely due to the lack of definitive guidelines. For at least the last five years, Excludes1 notes have eluded the AHA Coding Clinic  – much to the disappointment of coders.  Finally, though, the Q4 2018 Coding Clinic delivers clarity on diagnoses paired by an Excludes1 note.

  • CDC Introduced New ICD-10 Codes to Stop Human Trafficking

Among other notable ICD-10 developments this year, 29 new T codes that address human trafficking were introduced. These codes, published by the CDC last June, went into effect on Oct. 1. The American Hospital Association (AHA) had asked the ICD-10-CM Coordination and Maintenance committee to create these T codes as part of its Hospitals Against Violence initiative with the aim of equipping providers with the ability to document clients at risk of sex and labor exploitation. The AHA is encouraging coders to identify signs of abuse in the documentation and to employ the new T codes to report such cases.

The Road Ahead

Are you on top of these ICD-10 updates? You may be wondering how all this change your reimbursement? As changes will continue through 2019 and beyond, you’ll need to keep an eye out for what’s new and adapt quickly.

Stay in the know and prepare your team for claim success by investing in reliable ICD-10 resources — such as ICD-10 coding books (with complete code set, official ICD-10 coding guidelines, and numerous bonus features), newsletters, charts, and more.

Buy 2019 ICD-10 Code Books Bundle – TCI

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The 2019 ICD-10-CM and ICD-10-PCS code changes were released earlier than last year — but you cannot afford to postpone your preparations for Oct. 1. For ICD-10-CM, there are 279 new, 143 revised, and 51 deleted codes while for ICD-10-PCS, there are 392 additions, eight revisions, and 216 deletions.

Many of the 2019 ICD-10-CM codes focus on intricacies of disorders — from acute appendicitis and squamous cell carcinoma skin to ecstasy poisoning and fractures of the fingers. ICD-10-PCS introduces new codes for influenza vaccine, plazomicin anti-infective, and synthetic human angiotensin II along with hundreds of other inpatient procedure code updates.

Need help to fast track your learning of 2019 ICD-10-CM and ICD-10-PCS changes?

Zip through 2019 diagnostic and inpatient procedures code changes and get all the information you’ll need for accurate reporting with 2019 ICD-10 Books Bundle — packed with two essential ICD-10 coding books at a pocket-friendly price:

  • ICD-10-CM for Physicians & Hospitals 2019 Get new and revised ICD-10-CM codes and their descriptors, practical advice and key features — including the official ICD-10 coding guidelines, tips for interpreting guidelines for each Tabular chapter available online, official references, and colored highlights and symbols distinguishing HCC, RxHCC, MACRA, Z codes as first-listed diagnosis. Plus, highlighted vertical lines in the Alphabetic Index for indented terms make it easier to cross-reference codes to the Tabular List.
  • ICD-10-PCS Complete Code Set 2019 Get complete ICD-10-PCS code set, including 2019 code changes, official guidelines and conventions/additional conventions, full Index and Tables, an Approach Table with full definitions and examples, anatomical illustrations, and all the essentials you need to nail your inpatient procedures claims. You’ll also find reimbursement alerts along with several bonus features to assist your reporting.

2019 ICD-10-CM Code Changes – TCI

It’s been over a month since your practice started referring to 2019 ICD-10 coding books. You may be facing several challenges as you attempt to incorporate the new and revised diagnosis codes. Allow us to help by drawing your attention to a few unique scenarios.

ICD-10-CM Code Changes - TCI

A. Avoid Confusion Over New Expanded ICD-10-CM Codes

If you’ve gone through the 2019 ICD-10-CM code updates closely, you’ve possibly observed that many codes identified as deleted were essentially promoted to new roles. As many as 50 codes were revised to become parent codes of more specific codes — and this is creating some confusion, as some coding software have marked them as deleted and new.

Example: The malignant melanoma of right upper eyelid code C43.11 has ‘no change’ marked in CMS’ 2019 ICD-10-CM Addendum. In reality, it has two new codes added underneath for greater specificity — C43.111, C43.112. Likewise, the code C43.12 (left upper eyelid) also received new code options, but depending on your encoder, it will display the code as both new and deleted.

B. Follow These Rule-Out Rules for Better Coding

Are you aware that there are specific rules you need to follow if you come across documentation that refers to ruling out a diagnosis? Next time you find documentation that refers to ‘ruling out a diagnosis’, here’s what you need to keep in mind:

  • Appropriately Use Codes That Specify Ruled Out: ICD-10-CM includes some codes with the term ‘ruled out’ in the descriptor. More specifically look at these observation Z code categories: Z03.-, Z04.-, and Z05.- You should use these codes only when a person was in observation for a condition that was suspected and subsequently ruled out. Look to the 2019 ICD-10 coding guidelines to learn more about these codes.
  • Nail Down These Encounter Codes for Ruled-Out Maltreatment: According to 2019 ICD-10 coding guidelines, avoid using T76.- when the physician rules out the suspected maltreatment. Inclusion notes indicate that the following codes should be used when alleged rape or abuse is ruled out: Z04.41, Z04.42, Z04.71, and Z04.72. The latest guidelines also direct you to report Z04.81 and Z04.82 in cases where suspected exploitation is ruled out. For these rules, refer section I.C.19.f of 2019 official guidelines.
  • Avoid Inpatient Vs Outpatient Rule-Out Confusion: Note that inpatient and outpatient coding guidelines differ when there are terms of uncertainty for a diagnosis in the documentation. Inpatient reporting rules allow you to code a ‘still to be ruled out’ diagnosis, whereas outpatient rules do not.

To understand rule-out rules better and steer clear of inconsistencies, refer to current official ICD-10 coding guidelines. Be sure to report any inconsistencies and unique rules to your teammates and supervisors. Equip yourself and your staff with reliable and updated ICD-10 coding books, ICD-10 cheatsheets, and ICD-10 newsletters.

Source: ICD-10-CM Code Changes: There’s More to It Than Meets the Eye

What is New 2019 ICD-10-CM Codes? – TCI

Pay Attention to These New 2019 ICD-10-CM Codes to Maximize Reimbursement Success

2019 ICD-10-CM Codes to Maximize Reimbursement Success - The Coding Institute

The newest changes to the ICD-10-CM code set will go into effect in just a few days – but if you’re still waiting for the arrival of your 2019 ICD-10 coding books to start your preparation, here’s an overview of some new codes you’re using for your specialty effective Oct. 1:

Cardiology: Welcome New Cerebral Infarction & Cerebrovascular Disease Codes

Cardiology practices will now have two new codes I63.81 and I63.89 to report cerebral infarction under category I63-.The 2019 code set also adds new subcategory I67.85- under Category I67-. And under the new sub category, you’ll find two additional cerebrovascular disease codes: I67.850 and I67.858.

Gastroenterology: Find New Reporting Options for Abscess, Gallbladder Disorders, and More 

The 2019 ICD-10-CM code set introduces several new abscess codes K61.31 (horseshoe abscess), K61.39 (other ischiorectal abscess) and K61.5 (supralevator abscess). These codes will provide clarity when gastroenterology surgeons perform more invasive procedures.

In addition, you’ll see new codes for gallbladder disorders K82.A, K82.A1, and K82.A2 along with two new, more specific codes for cholangitis K83.01 and K83.09 that replaces the catch-all code K83.0.

Ophthalmology: Pay Attention to New Codes in Eyelid Cancer Category & Blepharitis 

Of all the specialties, ophthalmology has the maximum number of new codes this year. You’ll find several new codes in the eyelid cancer category, many of which were actually proposed by the AAO last year but were not implemented. Among the most notable updates are new codes under the C43.1 category that provides site-specific codes to specify which eyelid is affected, such as: C43.111, C43.112, C43.121, and C43.122.

Additionally, there are also new codes affecting laterality and upper/lower eyelid: C4A.1, C44.10, C44.11, C44.12, and C44.19. You’ll also find more site-specific codes for eyelid lesions in the “Neoplasms” section of ICD-10, including D03.11, D22.11, and D23.12.

This year’s crop of new codes also includes several new diagnoses related to blepharitis H01.00A, H01.00B, H01.01A, H01.01B, H01.02A, and H01.02B and a completely new categoryC44.13 that includes seven new codes to describe the site or whether the location is unspecified.

Eye care coders will also be pleased to find an entire new subcategory for paralytic ectropion of eyelid (H02.15) with seven code options, and new codes for multiple lagophthalmos conditions.

Ob-Gyn: Explore New Series of Multiple Gestation Codes, Surgical Wound Infection 

Ob-gyn specialty is also majorly impacted, with a new series of multiple gestation codes that specify that the number of chorions and amnions equal the number of fetuses. New codes for triplet pregnancies include: O30.131, O30.132, O30.133, and O30.139 with similar codes for quadruplet pregnancy: O30.231, O30.232, O30.233, and O30.239.

The infection of obstetric surgical wound code O86.0 expands to include six new codes, including O86.00 and O86.01. In addition, you will also find a new maternal depression screening code Z13.32.

There are also a bunch of new gynecology diagnoses that ob-gyn coders will need to master — such as N35.92. Plus, five new abnormal urine finding codes to use in place of existing code R82.99 that expands to include R82.991, R82.992, R82.993, R82.994, and R82.998.

Orthopedics: Use New Codes for Myalgia, Muscular Dystrophy

Orthopedics is also majorly impacted, including some significant additions that address myalgia — M79.10, M79.11, M79.12, and M79.18. You can also expect to report one out of the four new, more specific codes from the G71 series for muscular dystrophy.

Pediatrics: Don’t Overlook New Codes for Newborn Affected by Maternal Use

Pediatrics is also one of the top impacted specialties, with over 50 new codes. You’ll look forward to new codes for ‘newborn affected by maternal use’ of various drugs as well as more specific codes for Zika virus and child sexual exploitation and forced labor.

Urology: Dig Into New Urethral Stricture Codes

Urology figures among the top 10 specialties impacted by this year’s code changes, with 30 new codes to adopt. You’ll have a dozen new codes that address urethral stricture, both male and female, by the site of the stricture (N35), including N35.81, N35.811, and N35.812. The 2019 ICD-10-CM code set will also add eight more “unspecified” options to your urethral stricture coding armory.

Additionally, you’ll spot eight new codes being added to focus on postprocedural urethral stricture and abnormal findings in urine, such as N35.016, N35.116, N99.116, and R82.991, just to mention a few.

Assign New Codes with Confidence

You’ve got numerous new codes —and umpteen revisions — to analyze properly to secure your diagnostic coding compliance—and maximize your reimbursement success. To report accurately, consider investing in updated medical code books that includes new/revised ICD-10-CM codes and their descriptors, practical advice and key features — including the official ICD-10 coding guidelines, tips for interpreting guidelines, and more.

Source: New ICD-10-CM Codes for 2019

Nail 2019 ICD-10-CM Changes for Cardiology: Cerebral Infarction, Lipoprotein, Hyperlipidemia, Plasminogen Deficiency, & More

The addition of more specific codes will minimize the use of ‘other’ catch-all codes effective Oct. 1.

Cardiology coders got off fairly easy in terms of the 2019 ICD-10-CM Code Book set, which involves just 19 changes consisting of minor edits and a handful of new, more specific codes, along with changes to cardiology coding guidelines 2018.

2019 ICD-10-CM Changes for Cardiology

Despite the fact that your specialty isn’t as affected as much as other specialties, there’s still some important revisions to nail down — from cerebral infarction and elevated lipoprotein to hyperlipidemia and plasminogen deficiency.

Review these new code additions and revisions to get a jump on 2019 ICD-10-CM:

Take Stock of New & Revised Codes for Cerebral Infarction

Effective Oct. 1, you’ll use new cerebral infarction codes in Category I63- — I63.81 and I63.89 that replaces the existing ‘other cerebral infarction’ code 163.8.

The 2019 ICD-10-CM code set also brings cerebral infarction revisions your way — such as changing a plural word to singular or adding missing words for clarity. You’ll find such changes in code descriptors for I63.219 and I63.239 — where the word ‘arteries’ is changed to ‘artery’.

Note: Don’t miss the instructional note under category 163- with instructions to report an additional code.

Check Out Updated Hyperlipidemia & Plasminogen Deficiency Codes

Once the changes are effective, you’ll no longer report hyperlipidemia with E78.4. Instead you’ll use new codes — E 78.49 and E78.41. For plasminogen deficiency, you’ll use the new and more specific code E88.02 in place of E88.09. You’ll also have more specific code choices to report lipidemia and lipoprotein metabolism.

Look to New Subcategory Under Category 167-

Under category I67- (Other cerebrovascular diseases), you’ll find a new sub category I67.85- (Hereditary cerebrovascular diseases), with new codes: I67.850 and I67.858.

Here again, don’t forget to check out the new ‘code also’ note under I67.850 that directs you to report any associated diagnoses, such as epilepsy and recurrent seizures.

Don’t Miss These Blink-n-Miss Changes

Make sure you keep an eye out for numerous easy-to-miss revisions, such as a space between ‘true’ and ‘transmural’ in the code descriptor for myocardial infarction (acute) code I22.8; changes to coding notes, such as categories I60- through I69-; or even changes in an Excludes1 note for I77.6-.

Tap into This Resource as You Step Up Your Preparation

Staying updated with the 2019 ICD-10-CM codes is critical for your cardiology practice as knowing the revisions will help you avoid claim denials and reimbursement loss.

Check out TCI’s Cardiology Coding Alert to get clear, step-by-step explanations of all the cardiology-specific ICD-10-CM code updates, along with expert insight on cardiology coding guidelines 2018-2019, documentation best practices, real-world case studies, and more.