ICD 10 Coding Alert

Highlight this character for the radioactive isotope.

When you prepare to report a radiology oncology procedure, you need to pay particular attention to characters 3-6, as these specify the radiation, treatment type, modality, and radioactive isotope.

Review Your Seven Digit PCS Structure

When reporting any ICD-10-PCS code, you have seven characters. You can break them down as follows:

For radiation oncology services, you can focus on the first character of “D,” because “D” stands for “radiation oncology.”

Specifically, the main focus of your character selection should be the following:

Character 3 (Root Type)— This specifies the basic modality (beam radiation, brachytherapy, stereotactic radiosurgery, and other radiation).

Character 4 (Treatment Site) — This specifies the treatment site that is the radiation therapy’s target location.

Character 5 (Modality Qualify) — This character further specifies the treatment modality, which includes photons, electrons, heavy particles, and contact radiation.

Character 6 (Isotope) —This describes the radioactive isotope administered in the oncology treatment. 

Try Your Hand at This Example

Suppose you receive a claim that describes brachytherapy of the prostate with high dose rate (HDR) using Cesium 137. How should you report this?

Answer: DV1097Z.

Break it down: First of all, because this is a radiology oncology procedure, you should refer to the radiology oncology section (D).

Then, you’re looking at the prostate as the site, which leads you to the second character of “V” (Male reproductive system). So your code is “DV” so far.

Next, you have to decide the type of radiation. The claim described brachytherapy, so you should choose the third character of “1” (Brachytherapy). Your code is therefore “DV1.” That brings you to this PSC table:

Based on this table, you’ll choose “0” (Prostate) for the fourth digit. This is the target site of the radiation therapy. Your code is “DV10.”

The physician is delivering a High Dose Rate (HDR), so your next character is “9” (HDR). Your code is “DV109.”

The isotope is Cesium 137, so your next character is “7” (Cs-137). Your code is now “DV1097.”

Finally, you have no qualifier, so your complete code is “DV1097Z.”