The Centers for Medicare and Medicaid (CMS) has released the FY 2023 ICD-10-PCS codes and procedure coding and reporting guidelines, effective from October 1, 2022, through September 30, 2023. There are 331 new and 64 deleted codes, totaling 78,496 ICD-10-PCS codes for 2023. Medical billing and coding service providers will need to become familiar with these changes which will impact reimbursement for inpatient facilities such as acute and long-term care hospitals, skilled nursing facilities, hospices, and home health services.
CMS’ Version Update Summary, CMS includes an overall count of 2023 PCS code updates and also a list of code totals by section:
FY 2023 Update Summary
Change Summary Table
| 2022 Total | New Codes | Revised Titles | Deleted Codes | 2023 Total |
| 78,229 | 331 | 0 | 64 | 78,496 |
ICD-10-PCS Code FY 2023 Totals, By Section
| Medical and Surgical | 68,024 |
| Obstetrics | 304 |
| Placement | 861 |
| Administration | 1,257 |
| Measurement and Monitoring | 422 |
| Extracorporeal or Systemic Assistance and Performance | 51 |
| Extracorporeal or Systemic Therapies | 45 |
| Osteopathic | 100 |
| Other Procedures | 78 |
| Chiropractic | 90 |
| Imaging | 2,978 |
| Nuclear Medicine | 463 |
| Radiation Therapy | 2,056 |
| Physical Rehabilitation and Diagnostic Audiology | 1,380 |
| Mental Health | 30 |
| Substance Abuse Treatment | 59 |
| New Technology | 297 |
| Total | 78,496 |
Notable ICD-10-PCS Code Changes
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- New procedures codes for reporting laser interstitial thermal therapy (LiTT):
There are several new codes for destruction of various anatomical regions using laser interstitial thermal therapy (LiTT),a minimally invasive surgery for patients with drug-resistant epilepsy seizures that don’t respond to medication. LiTT involves using a laser guided by MRI to focus on and destroy a small portion of brain tissue. LiTT may be recommended for some people with seizures coming from one region of the brain, which are termed focal seizures. The new codes replace existing, less specific codes for reporting LITT, for e.g., 00500Z3 replaces D0Y0KZZ.
- New procedures codes for reporting laser interstitial thermal therapy (LiTT):
One point to note is that the LITT codes were relocated from the Radiation Therapy section to the Medical and Surgical section. This reason for this change is that LITT procedure thermal therapy to destroy soft tissue using heat generated by a laser probe and not ionizing radiation but rather.
- Medical and Surgical Section: This section has new codes for:
- Extraction of the cerebellum for procedures such as cavitron ultrasonic surgical aspiration (CUSA) for brain tumors
- Prostatic artery occlusion for embolization procedures
- Transferring the large/small intestine to a bladder/ureter
- Removal and Revision of Infusion device from the skull -for these procedures on previously inserted devices such as an Ommaya reservoir
- Drainage of the neck via a natural or artificial opening or natural or artificial opening endoscopic approach for drainage of parapharyngeal or retropharyngeal abscesses using a laryngoscope
The updated ICD-10-PCS code set also features added codes for therapeutic agents and several vein introduction codes.
- Updates in the New Technology Section: The ICD-10-PCS code set for FY 2023 has several new codes and some deletions in the technology section. There are new procedure codes for reporting the ISS500 neurological device indicated to increase cerebral blood flow and reduce disability in adult patients with acute ischemic stroke. 01HY3MZ, which is currently used to report implantation of a sphenopalatine ganglion stimulator for ischemic stroke, will be replaced by X0HQ3R8 starting Oct. 1.
There are also new codes for:
- Implantation of Sphenopalatine Ganglion Stimulator for Ischemic Stroke
- Paired Vagus Nerve Stimulation Therapy Using an External Controller
- Computer-Assisted Transcranial Magnetic Stimulation of the Prefrontal Cortex
- Histotripsy of Liver
- Posterior Vertebral Tether procedures
- Insertion in Bones and Fusion in Joints for Internal Fixation Devices with Tulip Connector
- Insertion of posterior spinal motion preservation device in joints
- Replacement of lateral and medial meniscus
- Extracorporeal Antimicrobial Administration during Renal Replacement
- Introduction of substances
- Measurement techniques
2023 ICD-10-PCS Guideline Changes
The FY 2023 ICD-10-PCS Guidelines for Coding and Reporting. Changes to the guidelines for FY 2023 includes:
- New Root Operation guideline B3.19 (Detachment procedures of extremities), and
- Two revised sections:
- Body Part general guideline B4.1c, and
- Device general guideline B6.1a.
The revision to the Body Part General Guideline B4.1c clarifies the meaning of a “continuous section of a tubular body part”.
- B4.1c FY 2022 Guideline: “If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the anatomically most proximal (closest to the heart) portion of the tubular body part.”
- FY 2023 B4.1c Revision: “If a singular vascular procedure is performed on a continuous section of an arterial or venous body part, code the body part value corresponding to the anatomically most proximal (closest to the heart) portion of the arterial or venous body part.”
The Device General Guideline B6.1a is that a device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded. It informs coders that when a device is intended to remain after the procedure is completed but requires removal before the end of the operative episode in which it is inserted, both the insertion and removal of the device should be coded.
In the 2023 ICD-10-PCS Official Guidelines for Coding and Reporting, CMS highlights the importance of proper clinical documentation and notes: “These guidelines have been developed to assist both the healthcare provider and the coder in identifying those procedures that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved.”
Documentation in the patient’s record is integral to accurate coding with the ICD-10. Thorough, detailed documentation is important for medical coding outsourcing companies to ensure accurate coding, which will lead to better patient care and appropriate and timely claims payments for hospitals.
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