Process for Requesting New/Revised ICD-10-PCS Procedure Codes

Process for Requesting New/Revised ICD-10-PCS Procedure Codes - MEARIS™

Although the ICD-10 Coordination and Maintenance Committee is a Federal Committee, suggestions for coding modifications come from both the public and private sectors. 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.

PUBLIC NOTIFICATION OF NEW ICD-10-PCS PROCEDURE CODE REQUEST SUBMISSION PROCESS

Effective March 1, 2022, the electronic intake system, Medicare Electronic Application Request Information System™ (MEARIS™), became active for ICD-10-PCS code request submissions. The ICD-10-PCS code request application can be accessed at: https://mearis.cms.gov.  CMS only accepts ICD-10-PCS code request applications submitted via MEARIS™. Requests submitted through the ICDProcedureCodeRequest mailbox will not be considered.

ICD-10-PCS code request submissions are due no later than December 6, 2024 to be considered for the March 18-19, 2025 ICD-10 Coordination and Maintenance Committee Meeting.

Within MEARIS™ there are several resources built in to support requestors:

• Please refer to the “Resources” section for guidance regarding the request application submission process at: https://mearis.cms.gov/public/resources.
• Technical support is available under “Useful Links” at the bottom of the MEARIS™ site
• Request application related questions can be submitted to CMS using the form available under “Contact” at: https://mearis.cms.gov/public/resources?app=icd-10-pcs
• The time required for request application submission, including the time needed to gather relevant information as well as to complete the form may be extensive depending on the nature of the code request. Requestors are therefore encouraged to start in advance of the due date to ensure adequate time for submission. 

ICD-10-PCS Procedure Code Requests

New ICD-10-PCS procedure code request submissions through MEARIS™ must include a background paper and also must include both a Section 508 Compliant PowerPoint and a PDF slide deck. The slides will be reviewed in consideration of presenting for a future ICD-10 C&M Committee meeting. Examples of procedure code background papers and slide presentations can be found in the agenda and meeting materials of previous meetings.

The responses provided to the questions in MEARIS™ for new ICD-10-PCS procedure code request submissions will be used to automatically populate a background paper that provides detailed information describing the procedure, the steps involved in the performance of the procedure, outcomes, any complications, and other relevant information. When providing your responses following the required paragraph format within MEARIS™, if this procedure is a significantly different means of performing a procedure that is already described in the classification, this difference should be clearly described. The responses provided within MEARIS™  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.

Coding Options: Possible new or revised code titles should then be recommended. CMS can assist with current coding and coding options once the background paper generated through MEARIS™ is reviewed.

Requestors should also indicate if the code request is for consideration for an April 1 implementation date or an October 1 implementation date. The  ICD–10 Coordination and Maintenance Committee makes efforts to accommodate the requested implementation date for each request submitted. However, the Committee determines which requests are to be presented for consideration for an April 1 implementation date or an October 1 implementation date. In addition, requestors should indicate whether they are submitting or intend to submit a New Technology Add-on Payment (NTAP) policy application related to the ICD-10-PCS procedure code request. If a NTAP application is not submitted as indicated or is withdrawn, the Committee will determine if it would be appropriate to postpone consideration of the request to a future time.

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 requestors’ background paper for presentation at the C&M meeting. The background paper is made publicly available on the CMS website in the Agenda and meeting materials packet approximately one month prior to the meeting for discussion during the C&M meeting. The background paper will include a CMS recommendation on any proposed coding revisions to facilitate discussion.

ICD-10 C & M virtual meetings are open to the public. A presentation is made during 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 virtual presentation on the clinical nature of the procedure. The clinical presentation at C & M meetings is limited to 10 minutes.  C&M meeting day schedules are always subject to last-minute changes, so we strongly suggest that requestors  select a back-up presenter in advance of the meeting to be available for their 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.  The public is also offered an opportunity to make additional written comments by e-mail. The timeline for the most recent meeting will include the deadline for comments on proposal from the most recent meeting, the scheduled dates for the next meeting, along with the deadline for receipt of modification proposals, and e-mail address(es) to send comments on proposals.

No decisions are made during 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 through a clearance process within the Department of Health and Human Services.