Process for Requesting New/Revised ICD-10-PCS Procedure Codes
Although the ICD-10 Coordination and Maintenance Committee is a Federal Committee, suggestions for coding modifications come from both the public and private sectors. Interested parties are asked to submit recommendations for modification three months prior to a scheduled meeting. Proposals for a new code should include a description of the code being requested, and rationale for why the new code is needed. Supporting references and literature may also be submitted. Proposals should be consistent with the structure and conventions of the classification. This process is described in more detail below. Requests for the March 9-10, 2021 meeting should be sent by December 4, 2020, to the following e-mail address ICDProcedureCodeRequest@cms.hhs.gov.
These meetings are open to the public; comments are encouraged both during the meetings and in writing. Recommendations and comments are carefully reviewed and evaluated before any final decisions are made. No decisions are made at the meetings. The ICD-10 Coordination and Maintenance Committee's role is advisory. All final decisions are made by the Director of NCHS and the Administrator of CMS. Final decisions made after the fall meeting generally become effective October 1 of the following year. An implementation exception is for codes capturing new technology. If a clear and convincing case is made that the new code is needed to capture new technology, this new code may be implemented on April 1 of the following year.
Official code revision packages, which are referred to as addenda, are available from this site for procedure addendum, and from NCHS' site for diagnosis addendum. The timeline for the most recent meeting will include the deadline for comments on the most recent meeting, the scheduled dates for the next meeting, along with the deadline for receipt of modification proposals, and the mailing address and e-mail address to send either modification proposals or comments on proposals. The public is offered an opportunity to make additional written comments by mail or e-mail. The agenda for an upcoming meeting is posted here approximately one month prior to the meeting.
As stated earlier, the CDC’s National Center for Health Statistics, , has the lead on ICD-10-CM diagnosis issues. CMS has the lead on ICD-10-PCS procedure issues.
ICD-10-PCS Procedure Code Revisions
The request for a procedure code change should be submitted at least three months prior to the C&M meeting. The request should include the following in a background paper:
Issue: Describe the procedure and why current ICD-10-PCS codes do not adequately capture the procedure
Background: provide detailed background information describing the procedure, the steps involved in the performance of the procedure, outcomes, any complications, and other relevant information. If this procedure is a significantly different means of performing a procedure that is already described in ICD-10-PCS, this difference should be clearly described. The background information should also include a description of the patients on whom the procedure is performed, the typical care setting in which the procedure is performed, and which diagnosis/diagnoses it is indicated to address. The manner in which coders are able to identify the performance of the procedure in the medical record and how the procedure is currently coded should be described along with information from the requestor on why they believe the current code is not appropriate.
Options: Possible new or revised code titles should then be recommended.
Examples of procedure code background papers presented at the ICD-10-CM/PCS Coordination and Maintenance Committee meetings can be found in agenda and handouts materials of previous meetings.
Once proposals are reviewed, all requestors will be contacted as to whether the proposal has been approved for presentation at the ICD-10 Coordination and Maintenance Committee meeting or not. If approved, CMS staff will update the requestor's background paper for presentation at the C&M meeting. The CMS background paper will include a CMS recommendation on any proposed coding revisions; however, alternative suggestions will also be considered during the meeting. The background paper is made publicly available via the Internet on the CMS website in the Agenda and Handout packet prior to the meeting for discussion at the C&M meeting.
A presentation is made at the C&M meeting, which describes the clinical issues and the procedure. The requestor will be given the opportunity to provide a presenter, who may or may not be a physician, to make a presentation on the clinical nature of the procedure. C&M meeting day schedules are always subject to last-minute changes, so we strongly suggest that you select a back-up presenter in advance of the meeting to be available for your topic if needed. CMS staff will lead a discussion of possible code revisions. The participants of the meeting are encouraged to ask questions concerning the clinical and coding issues and to offer recommendations. Recommendations concerning proposed code revisions stated during the C&M meeting, and followed up in writing before the end of the comment period, will be considered. Final decisions on code revisions are made through a clearance process within the Department of Health and Human Services. No final decisions are made at the meeting.