This page addresses follow-up questions and additional information pertinent to our webinar
2026 April ICD-10-PCS Code Updates: Exploring New Technologies and Code Changes.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic, as they can change rapidly.

Q: Both transmural and transpapillary drainage of the hepatobiliary system and pancreas have the same PCS approach – Via Natural or Artificial Opening Endoscopic. How do you tell the difference between these qualifiers?
A: Although both procedures share the same PCS approach – Via Natural or Artificial Opening Endoscopic – the distinction between transmural and transpapillary drainage lies in the anatomical route used to access the biliary or pancreatic system.

• • Transmural drainage is performed without crossing the ampulla of Vater. Access is typically created directly through the wall of the gastrointestinal tract, often using an esophagogastroduodenoscopy (EGD). The drainage is achieved through this newly created opening rather than through the natural ductal entry point.
  • Transpapillary drainage, on the other hand, is performed by crossing the ampulla of Vater. This is accomplished during an endoscopic retrograde cholangiopancreatography (ERCP), where the endoscope advances through the papilla into the biliary or pancreatic ducts to establish drainage.

In summary, while the PCS approach is the same for both procedures, the key differentiator is whether the ampulla of Vater is crossed. Careful review of the operative report – particularly documentation of EGD versus ERCP and whether the papilla was traversed – is essential for accurate qualifier assignment.

The X2K bypass portion of the ACSTERS procedure includes only the rerouting of blood flow from the vena cava to the pulmonary arteries. This component is coded to the appropriate bypass root operation based on its specific objective and anatomical site.

Bone marrow harvesting, however, represents a distinct procedural service. It has a separate root operation and a different procedural intent. Because ICD-10-PCS is built on the principle that each objective of a procedure is coded independently, the harvesting of bone marrow is not considered inherent to the bypass and is therefore assigned its own code.

This approach is supported by the following ICD-10-PCS Official Guidelines for Coding and Reporting:

Guideline B3.2c: When multiple procedures with distinct objectives are performed during the same operative episode, each procedure is coded separately.

Guideline E1.b: Procedures performed on different body parts or with different root operations are coded separately, even if performed during the same operative session.

Since the bypass and the bone marrow harvest involve different root operations and distinct procedural intents, separate ICD-10-PCS codes are required to accurately reflect the services performed.

Accurate coding ensures proper reporting, compliance, and reimbursement, and reflects the true scope of the operative work completed.

Q: How will the new ICD-10-PCS codes effective April 1, 2026 impact reimbursement, and how will these codes be incorporated into MS-DRG reimbursement?
A: CMS posted a notice regarding MS-DRG Version 43.1, effective April 1, 2026 on their website. This document indicates the OR designation, major diagnostic category (MDC), and MS-DRG for the 80 new PCS codes. This document can be found at: https://www.cms.gov/files/document/cms-announces-80-new-icd-10-pcs-codes.pdf.