These sections include imaging, nuclear medicine, radiation oncology, physical .... Intraoperative electron beam radiation therapy, left breast, DM003Z0.
Coding ICD-10-PCS Procedures in the Ancillary Sections: Understanding Imaging, Nuclear Medicine, and Radiation Therapy By Karen Kostick, RHIT, CCS, CCS-P, and Gina Sanvik, RHIA Editor’s note: This is the first installment of a two-part series of articles discussing the six Ancillary sections of ICD-10-PCS. This article continues the Journal of AHIMA’s exploration of the different sections of ICD-10-PCS, focusing on the six Ancillary sections. These sections include imaging, nuclear medicine, radiation oncology, physical rehabilitation and diagnostic audiology, mental health, and substance abuse treatment. Some of the Ancillary section character definitions differ from other sections, such as the Medical and Surgical section. For example, the Ancillary sections do not include root operations, but rather the root type of the procedure for these sections. Additional differences include:
Section C specifies the fifth character as radionuclide. Section D specifies the fifth character as modality qualifier and the sixth character as isotope. Section F specifies the fifth character as type qualifier and the sixth character as equipment. Sections G and H specify the fourth character as a type qualifier.
The Six Ancillary Sections of ICD-10-PCS Section Value
Description
B
Imaging
C
Nuclear Medicine
D
Radiation Therapy
F
Physical Rehabilitation and Diagnostic Audiology
G
Mental Health
H
Substance Abuse Treatment
Imaging: Section Value B The Imaging section consists of 2,934 codes. The first character value for the Imaging section is B. The second character specifies the body system on which the imaging procedure is performed. The third character, root type, indicates the type of imaging procedure. The fourth character indicates the body part or body region studied. The fifth and sixth characters define contrast and contrast/qualifier respectively. For example, the fifth character specifies
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the contrast that may be used in the procedure (i.e., high osmolar, low osmolar). The sixth character, which is specified as a qualifier, indicates unenhanced and enhanced for MRI procedures. The seventh character is also indicated by a qualifier that has a unique meaning for limited individual imaging procedures which include intravascular, transesophageal, guidance, and densitometry. Character three imaging root types consist of the following five procedures:
Plain Radiography: Planar display of an image developed from the capture of external ionizing radiation on photographic or photoconductive plate. Fluoroscopy: Single plane or bi-plane real time display of an image developed from the capture of external ionizing radiation on a fluorescent screen. The image may also be stored by either digital or analog means. Computerized Tomography (CT Scan): Computer-reformatted digital display of multiplanar images developed from the capture of multiple exposures of external ionizing radiation. Magnetic Resonance Imaging (MRI): Computer-reformatted digital display of multiplanar images developed from the capture of radio-frequency signals emitted by nuclei in a body site excited within a magnetic field. Ultrasonography: Real time display of images of anatomy or flow information developed from the capture of reflected and attenuated high frequency sound waves.
The character five values identify whether or not contrast material is used for the imaging procedure. The values are specified as high-osmolar contrast media, such as Diatrizoate, low-osmolar contrast media, such as Omnipaque, other contrast, or none. The character six values provide further specificity for the imaging procedure and are identified as unenhanced and enhanced, laser, and intravascular optical coherence.
Imaging Coding Examples in ICD-10-PCS The following are two examples of coding for Imaging in ICD-10-PCS. An example of Left ventriculography using omnipaque contrast in ICD-9-CM is available online in an extended version of this article in AHIMA’s HIM Body of Knowledge. CT of brain without contrast material followed by diatrizoate contrast, B02000Z Character Character Character Character Character Character 2 1 3 4 5 6 Body Section Root Type Body Part Contrast Qualifier System
Character 7 Qualifier
Imaging
Central Nervous System
CT Scan
Brain
High Osmolar
Unenhanced and None Enhanced
B
0
2
0
0
0
Z
Left ventriculography using omnipaque contrast, B2151ZZ Character Character Character Character Character Character 2 1 3 4 5 6 Body Section Root Type Body Part Contrast Qualifier System
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Character 7 Qualifier
Imaging
Heart
Fluoroscopy Heart, Left
Low Osmolar
None
None
B
2
1
1
Z
Z
5
Nuclear Medicine: Section Value C Nuclear medicine offers a unique ability to provide information about both the structure and function of every major organ system within the body. The ability to characterize and quantify physiologic function is what separates nuclear medicine from other types of imaging modalities.1 The Nuclear Medicine section consists of 463 codes. The first character for the Nuclear Medicine section is C. The second character specifies the body system and the third character, root type, indicates the type of nuclear medicine procedure. The fourth character further specifies the body part or body region studied with regional (i.e., upper extremity) and combination (i.e., kidneys, ureters, and bladder) body part values assigned in this section. The fifth character identifies the radionuclide, the radiation source. The sixth and seventh characters are not specified in the nuclear medicine section and are assigned the value Z, none. Character three nuclear medicine root types consist of the following seven diagnostic and therapeutic procedures:
Planar Nuclear Medicine Imaging: Introduction of radioactive materials into the body for single plane display of images developed from the capture of radioactive emissions. Tomographic (Tomo) Nuclear Medicine Imaging: Introduction of radioactive materials into the body for threedimensional display of images developed from the capture of radioactive emissions. Nonimaging Nuclear Medicine Uptake: Introduction of radioactive materials into the body for threedimensional display of images developed from the simultaneous capture, 180 degrees apart, of radioactive emissions. Nonimaging Nuclear Medicine Probe: Introduction of radioactive materials into the body for the study of distribution and fate of certain substances by the detection of radioactive emissions from an external source. Nonimaging Nuclear Medicine Assay: Introduction of radioactive materials into the body for the study of body fluids and blood elements, by the detection of radioactive emissions. Systemic Nuclear Medicine Therapy: Introduction of unsealed radioactive materials into the body for treatment.
There are 22 character five radionuclide values, and examples include technetium 99m (Tc-99m), iodine-131 (I131), gallium 67 (Ga-67), and thallium 201 (Tl-201). The character value, other radionuclide, is utilized for newly added Food and Drug Adminstration radiopharmaceuticals.
Nuclear Medicine Coding Example in ICD-10-PCS The following is an example of coding for Nuclear Medicine in ICD-10-PCS. These types of ancillary procedures are not typically coded in ICD-9-CM, so an example is only provided for ICD-10 for the purposes of this article. Gallium 67 citrate scan of chest, single plane imaging, CW1BLZZ
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Character Character 2 1 Body Section System
Character Character Character Character 3 Character 5 4 6 7 Root Radionuclide Body Part Qualifier Qualifier Type
Nuclear Medicine
Planar Anatomical Nuclear Regions Medicine Imaging
Chest
C
W
3
1
Gallium 67 None
None
Z
Z
(Ga-67) L
Radiation Therapy: Section Value D The Radiation Therapy section consists of 1,939 codes. The first character value for the Nuclear Medicine section is D. The second character of a code from this section specifies the body system. The third character is the root type and defines the treatment modality. The fourth character specifies the radiation treatment site. The fifth character further defines the treatment modality and the sixth character identifies the presence of any isotopes introduced into the body. The seventh character identifies whether or not the procedure was performed intraoperatively. Character three radiation therapy root types consist of the following four procedures:
Beam Radiation Brachytherapy Stereotactic Radiosurgery Other Radiation
Character five includes 16 modality values, and examples include photons
