Final FY21 ICD-10-PCS Codes Are Here

The FY21 ICD-10-CM codes will be finalized this month.

The Centers for Medicare and Medicaid Services (CMS) released the final FY21 ICD-10-PCS codes on May 28, 2020 which was earlier than expected.  The table below will show the changes between Final FY20, Proposed FY21, and Final FY21:

Section FY20 Proposed FY21 Final FY21 Change FY20 – FY21
Medical & Surgical 67,257 67,380 67,655 398
Obstetrics 302 302 304 2
Placement 861 861 861 0
Administration 1,332 1,332 1,336 4
Measurement & Monitoring 418 419 421 3
Extracorporeal/Systemic Assistance & Performance 48 49 51 3
Extracorporeal/Systemic Therapies 46 46 46 0
Osteopathic 100 100 100 0
Other Procedures 77 78 78 1
Chiropractic 90 90 90 0
Imaging 2,941 2,969 2,973 32
Nuclear Medicine 463 463 463 0
Radiation Therapy 2,019 2,083 2,087 68
Physical Rehabilitation & Diagnostic Audiology 1,380 1,380 1,380 0
Mental Health 30 30 30 0
Substance Abuse Treatment 59 59 59 0
New Technology 136 142 169 33
Totals 77,559   78,103 544

This table will assist you in determining where to focus education and facility guideline updates.  In the Medical and Surgical Section, the root operation, Fragmentation, was added to several systems with percutaneous approach and ultrasonic qualifier.The device, Radioactive Element, was added to Central and Peripheral Nervous Systems; Ear, Nose, and Throat; Mouth and Throat; Gastrointestinal; Hepatobiliary System and Pancreas; Endocrine; Urinary; Female Reproductive; and Male Reproductive systems. A contractility modulation device was added to the Subcutaneous and Connective Tissue section.   The external fixation device was added to the 0QP Table.   An internal fixation device with sustained compression was added to Fusion for Lower Joints and Upper Joints. The root operation, Transplantation, was added to the Male Reproductive System.

In the Imaging Section, a fluorescing agent was added to contrast and bacterial autofluorescence was added to Qualifier options to some tables.  Radiation Therapy added isotope of Cesium 131.    The New Technology Section added new devices and new substances such as the following:

  • Brexanolone
  • Nerinitide
  • Durvalumab (Anti-neoplastic)
  • Lefamulin Anti-infective
  • Synthetic Substitute Mechanically Expandable
  • Cerebral Embolic Filtration, Extracorporeal Flow Reversal Circuit
  • Mineral-based Topical Hemostatic Agent
  • Eladocagene exaparvovec
  • Brexucabtagene Autoleucel Immunotherapy
  • Lisocabtagene Maraleucel Immunotherapy
  • Infection, Positive Blood Culture Fluorescence Hybridization for Organism Identification, Concentration, and Susceptibility
  • Infection, Lower Respiratory Fluid Nucleic Acid-base Microbial Detection

The New Technology additions give us a glimpse into possible New Technology Add-On Payments for FY21.

It is important to review these updates and determine if there are any changes in coding processes as well as identifying documentation in the electronic medical record which is applicable to the new procedures. It is also important to update your facility guidelines if any changes are made in the coding process.   Keep a version for FY20 so the applicable guidelines can be matched to the dates of service during a coding review or regulatory audit.

The FY21 ICD-10-CM codes will be finalized this month. The Final Rule for FY21 will be expected by August 7, 2020. More changes are on the way.

Programming Note: Laurie Johnson is a permanent panelist on Talk Ten Tuesdays. Listen to her live coding report every Tuesday, 10-10:30 a.m. EST.


FY21 ICD-10-PCS:

FY21 ICD-10-PCS Official Coding and Reporting Guidelines:

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