Editor's Note: This is part three of the three-part coding series. Parts one and two, authored by Deborah Neville, can be view here (Part One) (Part Two). You can also Watch Neville's popular ADVANCE webinar here. 

The first two articles in this series gave an overview of the steps required to successfully implement the ICD-10-CM/PCS system. They included important information on the preparation and planning needed to successfully transition to ICD-10. In this final article, we look at specific areas for radiology coding in the procedure coding system, ICD-10-PCS, beginning with a little background on the ICD-10-CM/PCS systems.

The ICD-10-CM/PCS systems are to be implemented on Oct. 1, 2013, replacing ICD-9-CM as the HIPAA-approved code sets. There are two parts to the system; ICD-10-CM for the diagnoses, which replaces the diagnosis codes from ICD-9-CM and ICD-10-PCS, which replaces the procedure codes found in ICD-9-CM. As noted in the second article, the use of the CPT procedure coding system will not change with the implementation of the ICD-10 based systems. If you use CPT now, for example in outpatient settings, you will continue to use CPT after Oct. 1, 2013. This article will highlight some of the aspects of ICD-10-PCS that might be applicable in the radiology setting, particularly the ancillary sections of ICD-10-PCS.

The ICD-10-PCS System

For inpatient procedures, the ICD-10-PCS system will replace the ICD-9-CM procedure codes currently in use. This system is completely different than the I-9 based system, and some adjustments must be made in the coding process.

Information about the coding system, including the code tables and index can be found at: https://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp

All ICD-10-PCS codes consist of seven characters and all characters must have a value assigned. The first character is for the section. Radiology services are most frequently found in two of the Ancillary sections; Imaging, Section B and Radiation Oncology, Section D. While many of the ICD-10-PCS codes for imaging services may be captured via a computerized charge master, we will look at the basic code structure for this section to build familiarity with the codes.

Generally, the first step in coding the services is to review the index for the type of service performed and refer to the code tables indicated in the index reference. By reviewing the code table, the remaining portions of the code can be assigned. To understand this process we will look at the components of the Imaging and Radiation Oncology sections and codes.

Imaging codes

The first character will be a B, indicating that this is an Imaging code. The second character is for the body system involved, for example 2 for the Heart. The third character is for the root type, one of four possibilities, Plain Radiography (0), Fluoroscopy (1), CT (2), MRI, (3) or Ultrasonography (4). The fourth character indicates the specific body part involved in the imaging, for example 0 for a single coronary artery. The fifth character is for contrast, either high osmolar (0), low osmolar (1), other contrast (Y) or none (Z). Some codes have a value for the sixth character, the qualifier. For example, unenhanced and enhanced, (0), laser (1) or intravascular optical coherence (2) or no qualifier (Z). A very limited number of codes include a value for the seventh character, the second qualifier, for example 0 for Intraoperative. If no qualifier is applicable, the Z is used.

As an example, if the service to be coded was an Intraoperative laser fluoroscopy of a single coronary artery using high osmolar contrast, the main term Fluoroscopy would be referenced in the index, with the subterms artery, coronary, single and laser, Intraoperative. After consulting the B21 table, the complete code would be B210010.

 Radiation oncology codes

The seven characters for these codes follow similar characteristics as in the Imaging codes. The first character for the section is always a D. The second character is for the body system, for example B for respiratory system. The third character is for the root type or basic modality of the service. There are four possibilities, Beam Radiation (0), Brachytherapy (1), Stereotactic Radiosurgery (2) and Other Radiation (Y). The fourth character indicates the specific body part involved, for example lung (2) in the Respiratory system. The treatment modality is reflected in the fifth character, for example high dose rate (9) or low dose rate (B). If an isotope is used this is reflected in the sixth character, for example, Cesium 137 (7) or Iodine 125 (9). If there is not an isotope used, the Z is the value used for this character. In most cases, the final character is a Z for No Qualifier. However, if the Radiation Oncology service is performed intraoperatively, the qualifier would be 0.

Using the example of an Intraoperative beam radiation treatment to the prostate using electrons, the entire code can be located in the index under the main term Beam Radiation and the subterms prostate and Intraoperative, DV003Z0. Looking at the DV0 table, the entire code can be referenced:

A working knowledge of how the coding system is designed and how codes are assigned can help to understand the documentation needed to successfully represent the procedures performed. ICD-10-PCS for procedures is a completely new system and taking the time now to understand the structure will ease the transition leading up to the implementation date of Oct. 1, 2013.

Therese (Teri) M. Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA is a product specialist for MC Strategies and an Assistant Professor at the University of Illinois at Chicago. She is an AHIMA Certified ICD-10-CM/PCS Trainer and a member of the AHIMA Academies External Faculty.