This page addresses follow-up questions and additional information pertinent to our webinar
ICD-10-PCS Coding Updates FY 2027: Beyond the Tables and Into the Why.

** 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: How do the new 028 codes for division of aortic and mitral valve leaflets differ from the existing X28 New Technology codes?

A: The X28 codes continue to be used when leaflet division is performed using one of the two specifically identified technologies: the TELLTALE® Electrosurgical Guidewire System or the Pi-Cardia ShortCut™ Catheter. For other methods of percutaneous valve leaflet division, the new 028 codes are reported. These codes distinguish the valve treated (aortic or mitral) and use a qualifier to identify whether the leaflet is native or prosthetic.

Key takeaway:
TELLTALE® or ShortCut™ → X28
Other methods of leaflet division → 028, with the qualifier identifying native vs. prosthetic leaflet.

Q: How does the Arcevo™ LSA Hybrid Stent Graft differ from the NEXUS® Aortic Arch Stent Graft System?

A: The key difference is the type of repair and branch vessel treated:

• Arcevo™ is a hybrid surgical/endovascular device used during open aortic arch repair. It includes a stented branch for the left subclavian artery (LSA), reducing the need for a separate surgical LSA anastomosis.
• NEXUS® is a fully endovascular, modular aortic arch system. It uses separate stent-graft components in the ascending aorta, aortic arch, and brachiocephalic artery, with an optional descending extension.

Key takeaway: Arcevo supports an open hybrid arch repair, while NEXUS provides a fully endovascular arch repair.

Q: How does insertion of a CCM-D system differ from insertion of a cardiac contractility modulation (CCM) system or an implantable defibrillator?

A: A standard CCM system and an implantable cardioverter-defibrillator (ICD) provide different therapies and are typically implanted as separate devices. CCM therapy delivers electrical signals during the heart’s refractory period to improve ventricular contraction and heart failure symptoms, while an ICD monitors for life-threatening ventricular arrhythmias and delivers defibrillation therapy to prevent sudden cardiac death.

The investigational CCM-D system combines both CCM and ICD functions into a single implanted generator, allowing patients who need both therapies to receive one device during a single implantation procedure rather than separate CCM and ICD systems.

Key takeaway: The distinction is the combined functionality of the device—CCM-D provides both heart failure contractility therapy and defibrillation therapy in one system.

Q: How does the SpyGlass™ Discover single-use choledochoscope differ from the EXALT™ Model D single-use duodenoscope? If both scopes are used during the same procedure, can both be coded?

A: The key difference is where the scope is positioned and the route used to reach the pancreaticobiliary ducts.

EXALT Model D is a single-use duodenoscope used during ERCP. It is passed through the mouth and GI tract into the duodenum, where it provides access to the ampulla and pancreaticobiliary ducts. The existing XFJ codes identify inspection of the hepatobiliary or pancreatic duct using a single-use duodenoscope with the via natural or artificial opening endoscopic approach. CMS has recommended retaining these codes in Section X for FY 2027.

SpyGlass Discover is a much smaller single-use choledochoscope designed to provide direct intraductal visualization. It is advanced into the pancreaticobiliary system through a laparoscopic port, percutaneous access, or another endoscope channel, and may also accommodate instruments for stone treatment, biopsy, or other therapy. For FY 2027, CMS proposed new XFJ codes for SpyGlass Discover-type single-use choledochoscopy using the percutaneous or percutaneous endoscopic approach.

Can both be used? Potentially, but they serve different roles. A duodenoscope can function as the larger access platform through which a smaller intraductal scope is introduced; this is how cholangioscopy is commonly performed during ERCP. CMS specifically describes a single-use cholangioscope being advanced through the working channel of a duodenoscope into the bile or pancreatic duct. However, SpyGlass Discover specifically is primarily described for laparoscopic and percutaneous procedures, whereas the related SpyGlass DS II system is the SpyGlass platform described by CMS for cholangioscopy performed through a duodenoscope during ERCP.

Coding takeaway: Do not automatically report both XFJ codes simply because two scopes were present. Code assignment should reflect the technology, approach, and inspection actually performed and documented. If distinct reportable inspections using different technologies and approaches are performed, separate codes may be appropriate; ICD-10-PCS generally requires separately reportable procedures to be coded individually rather than using combination codes.

Key takeaway: EXALT gets you to the duct; SpyGlass provides a close-up view inside the duct. But for SpyGlass Discover, pay particular attention to the documented access route because its FY 2027 codes are designed around percutaneous/percutaneous endoscopic use, not the traditional ERCP route.

Q: How does the new XEZ procedure for computer-assisted triage and notification differ from Sepsis ImmunoScore, which is also used to identify patients at risk for sepsis?

A: Although both technologies use software to analyze clinical data and help identify patients at risk for sepsis, they function differently and therefore represent different ICD-10-PCS concepts.

Sepsis ImmunoScore – Measurement (XXEZXCB)

• • • Initiated when ImmunoScore is ordered for a hospitalized patient with suspected sepsis.
    • Uses biomarker and clinical data, including up to 22 parameters obtained from the EHR.
    • Produces a risk score and one of four risk categories ranging from low to very high risk.
    • Represents a measurement/risk assessment at a defined point in the patient’s evaluation.
    • The resulting score supports clinical decisions regarding diagnosis, triage, and escalation of care.

Bayesian Health Sepsis Flagging Device – Computer-Assisted Triage and Notification (XEZ)

• • • Continuously monitors the EHR rather than relying on a single ordered assessment.
    • Reassesses the patient’s risk each time new clinical information or an event is entered into the EHR.
    • Uses a broad range of structured and unstructured clinical information, such as vital signs, laboratory results, notes, medications, procedures, and orders.
    • When the calculated risk meets the threshold for “Sepsis High Risk,” the software places a flag in the EHR to alert the care team.
    • Providers can review the factors contributing to the high-risk determination to support treatment-management decisions.

Key takeaway: Both are AI-based clinical decision-support tools for sepsis, but Sepsis ImmunoScore performs a discrete measurement that produces a sepsis risk score/category, while the Bayesian Health Sepsis Flagging Device continuously evaluates evolving EHR data and generates a notification when a patient meets the high-risk threshold. This difference supports classification of ImmunoScore as Measurement versus the Bayesian Health technology as Computer-Assisted Triage and Notification.

Q: BlackArmor® Carbon/PEEK sounds familiar. Isn’t there already an ICD-10-PCS code for this device?

A: Yes. BlackArmor® Carbon/PEEK technology is already represented in ICD-10-PCS with XRH60FA for the VADER® Pedicle System. However, the VADER® and CMORE® CT systems are designed for different areas of the spine and have different fixation options.

• • VADER® Pedicle System: Used for stabilization of the thoracic and lumbar spine and utilizes pedicle screw fixation.
  • CMORE® CT System: Used for stabilization of the cervical and thoracic spine and may utilize either pedicle or lateral mass screw fixation, depending on the patient’s anatomy.
  • Both systems are manufactured using BlackArmor® Carbon/PEEK, a radiolucent material that reduces imaging artifact and improves postoperative visualization with MRI and CT.

Why the distinction?
Although both systems use the same BlackArmor® Carbon/PEEK technology, CMORE® is a separate stabilization system specifically designed for the smaller anatomy of the cervicothoracic spine. Because CMORE® may use either pedicle or lateral mass fixation, it is described more broadly as a “spinal stabilization device,” whereas VADER® is specifically described as “spinal stabilization, pedicle based.”

Key takeaway: The new CMORE® codes do not simply represent another use of the same device. They distinguish a different spinal stabilization system with different anatomic applications and fixation options from the existing VADER® Pedicle System code.