March 26, 2013

Building an ICD-10-PCS Foundation for Radiology Procedures

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When October 1, 2014, rolls around, the ICD-10-PCS (procedural coding system) will replace the ICD-9-PCS currently used for inpatient procedures. Code assignments under this system will be very different for all inpatient coding professionals, starting with the idea that they will need to “build” a seven-character code—either for medical-surgical procedures or ancillary services, which include imaging, nuclear medicine, and radiation oncology.

 

Available Radiology Characters

For each character in each code, one of 34 possible values has been assigned. Each character’s physical position in the code is important because the same letter or number placed in a different character means something different. The values are identified with the numbers 0 through 9 and all letters in the alphabet except I and O. The reason for excluding I and O, according to the Centers for Medicare & Medicaid Services (CMS), is that they look too much like the numbers 1 and 0 and could cause confusion. The value assigned depends upon specific details of the procedure performed.

For example, in the imaging section, the fifth character defines the use of high or low osmolar contrast media. Specifically, a “Z” indicates no contrast; a “Y” indicates other contrast; high osmolar is identified by a “0.”

The sixth character is a qualifier that defines whether an image was taken without contrast followed by one with contrast. A “Z” indicates none or no contrast, and a “0” is defined as “unenhanced and enhanced.”

The seventh character also is a qualifier that is not specified for imaging procedures, and it is always Z.

For imaging services, the following characters are chosen.

1—Section (B = imaging)

2—Body system

3—Root type

4—Body part

5—Contrast material

6—Qualifier

7—Qualifier

With minor exceptions, nuclear medicine is organized like the above. In the first character, the section would be C, identifying a nuclear medicine procedure. The fifth character defines the radionuclide (radiation source) instead of the contrast material used in the procedure.

For radiation oncology (radiation procedures performed for cancer treatment), characters 1–4 are the same as imaging above. The differences in the character are as follows:

5—Specific treatment modality

6—Radioactive isotope used, if applicable.

7—Qualifier

Values Vary

As you can see above, each character represents a specific aspect of the procedure—called a “value.” The root type (third character) varies by modality, and the values for each of the radiology procedures are listed below.

Imaging Procedures

Values

Descriptions

0

Plain radiography

1

Fluoroscopy

2

Computerized tomography (CT scan)

3

Magnetic resonance imaging (MRI)

4

Ultrasonography


Nuclear Medicine

Values

Descriptions

1

Planar

2

Tomographic (tomo)

3

Positron emission tomography (PET)

4

Nonimaging nuclear medicine uptake

5

Nonimaging nuclear medicine probe

6

Nonimaging nuclear medicine assay

7

Systemic nuclear medicine therapy

 

Radiation Oncology

Values

Descriptions

0

Beam radiation

1

Brachytherapy

2

Stereotactic radiosurgery

Y

Other radiation

 

Putting it Together

Several examples of building a code can be found in The ICD-10-PCS Reference Manual. Several of these are provided below for the three types of radiology procedures above. Note that the description of the character appears first in each column with the character following in parenthesis.

Section

Body System

Root Type

Body Part

Contrast

Qualifier

Qualifier

Example: X-ray of right clavicle, limited study (Code BP04ZZZ)

Imaging (B)

Non-axial upper bones (P)

Plain radiography (0)

Clavicle, right (4)

None (Z)

None (Z)

None (Z)

Example: MRI of liver using Gadoteridol (Code BF35YZZ)

Imaging (B)

Hepatobiliary and pancreas (F)

Magnetic resonance imaging (3)

Liver (5)

Other contrast (Y)

None (Z)

None (Z)

Example: Adenosine sestamibi (technetium) planar scan of heart muscle at rest (Code C21G1ZZ)

Nuclear medicine (C)

Heart (2)

Planar nuclear (1)

Myocardium (G)

Technetium 99m (1)

None (Z)

None (Z)

Example: Technetium tomo scan of liver (Code CF251ZZ)

 

 

 

 

 

 

 

Nuclear medicine (C)

Hepatobiliary and pancreas (F)

Tomo nuclear imaging (2)

Liver (5)

Technetium 99m (1)

None (Z)

None (Z)

Example: LDR brachtherapy of cervix using Iridium 192 (Code DU11B8Z)

Radiation oncology (D)

Female reproductive (U)

Brachytherapy (1)

Cervix (1)

LDR brachytherapy (B)

Iridium 192 (8)

None (Z)

Example: Intraoperative radiation therapy (IORT) of bladder (Code DTY2CZZ)

Radiation oncology (D)

Urinary system (T)

Other radiation (Y)

Bladder (2)

IORT (C)

None (Z)

None (Z)

 

 

 

For the reference manual, go to http://cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html and review the list under Downloads.

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Donna Richmond, BA, RCC, CPC

Donna's more than 20 years’ experience in billing, coding and compliance include positions as Coding Services Manager for a computer-assisted coding company, directing 30+ coders and assisting clients with coding questions; and billing, coding and compliance responsibilities for a practice management / billing company. Donna is a past member of the Radiology Business Management Association (RBMA) Programs committee and Chairman of the Coding sub-committee. She was the Radiology Coding Certification Board’s RBMA Liaison for 2 years and previously served on the Education Committee. In addition to Donna’s coding hotline responsibilities for Panacea, she performs a variety of Radiology and Cardiology audits, contributes to several publications and webcasts.