Updated on: September 23, 2013

ICD-10-CM and ICD-10-PCS: Interventional Radiology Exercise

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Original story posted on: December 19, 2011

Below is an example of a computerized tomography (CT) guided core biopsy of the liver as well as the ICD-10-CM and ICD-10-PCS codes that should be assigned for this outpatient encounter.

Preoperative Diagnosis: Malignant neoplasm liver, primary

Postoperative Diagnosis: Malignant neoplasm liver, primary

Procedure: CT guidance, liver core biopsy

Anesthesia: Local anesthesia

Procedure Description: CT, biopsy liver core

Technique/Findings: Informed consent was obtained. The patient was placed in a supine position. CT images were obtained to localize the small hypervascular liver mass for biopsy. The mass was somewhat difficult to visualize. Anatomic landmarks were used for the preliminary needle placement. The skin was prepped using sterile technique and 1% lidocaine plain was used for local anesthesia.

A 17 gauge Bard TruGuide needle was advanced to the edge of the liver mass using anatomic landmarks and CT guidance. Five core samples were obtained and sent to pathology.

Code Assignments

In the first table below is a comparison of the ICD-9 diagnosis codes and the ICD-10 diagnosis codes. As you can see, the descriptors are almost identical.

ICD-9-CM Diagnosis Codes

ICD-10-CM Diagnosis Codes

155.0 Malignant neoplasm of liver, primary

C22.8 Malignant neoplasm of liver, primary, unspecified to type

 

Each digit of the ICD-10 codes identifies a different element of the system. The ICD-10 code listed above would be broken down as follows:

  • C = Chapter 2: Neoplasm
  • 22 = malignant neoplasm of liver and intrahepatic bile ducts
  • 8  =  primary, unspecified as to type

 


 

Now review the second table below, which lists the ICD-9 procedure codes against the ICD-10 procedure codes. You will see similar descriptors. Even though ICD-9-CM procedure codes would not be reported in the outpatient setting (per HIPAA guidelines), they are provided below for illustrative purposes.

ICD-9-CM Procedure Codes

ICD-10-PCS

50.11 Closed (percutaneous /needle) biopsy of liver

88.01 Computerized axial tomography of abdomen

0FB03ZX  Excisional percutaneous liver biopsy

BW20ZZZ Computerized tomography (CT scan) of abdomen

Like the ICD-10 diagnosis codes, each digit in the ICD-10-PCS column identifies a specific feature, as indicated below, in the code:

For the first code (excisional percutaneous liver biopsy):

  • 0 = medical surgical
  • F = hepatobiliary system and pancreas
  • B = excision (cutting out or off, without replacement, a portion of a body part)
  • 0 = liver
  • 3 = percutaneous
  • Z = no device
  • X = diagnostic

For the second code (CT guidance):

  • B = imaging
  • W = anatomical regions
  • 2 = CT scan
  • 0 = abdomen
  • Z = none
  • Z = none
  • Z = none

 


 

In addition, for the above outpatient case, you will need to assign the following CPT procedure codes:

47000 Biopsy of liver, needle; percutaneous

77012 CT guidance for needle placement, radiology supervision and interpretation

Listed below are website links to the latest version of ICD-10-CM and ICD-10-PCS:

About the Author

Patricia A. Shell is a senior healthcare consultant with Medical Learning, Inc. (MedLearn®), a Panacea Healthcare Solutions Company, St. Paul, MN. She has more than 30 years of experience in billing, coding, and compliance.

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