Inpatient Facility Coding & Compliance Alert

Type of treatment and isotope help guide your selection.

ICD-10-PCS implementation is coming soon: October 1, 2014. Once the system goes into effect, you’ll need to pay special attention to characters 3-6 when reporting radiation oncology procedures because they specify the radiation, treatment type, modality, and radioactive isotope.

Brush Up On Basic PCS Structure

When reporting any ICD-10-PCS code, you have seven alphanumeric 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. 

Practice With an 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? The correct answer is DV1097Z.

Explanation: 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 need to decide the type of radiation. The claim described brachytherapy, so you should choose the third character of “1” (Brachytherapy). Your code is at this point is “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.”