Preliminary 12/10/07 Chapter 4 Procedures in the ancillary sections T HIS CHAPTER PROVIDES reference material for procedure codes in the six ancillary sections of ICD-10-PCS (B–D, F–H). Codes in these sections contain characters not previously defined, such as contrast, modality qualifier and equipment. First, a table is provided, listing the sections in order. Following the table, reference material is provided for each section, and includes u General description of the section u A table listing each root type in the section, with its corre- sponding definition (sections B, C and F only) u Coding notes as needed u Representative examples of procedures coded in that section, in table excerpt format, with explanatory notes as needed u Coding exercises that provide example procedures and their corresponding ICD-10-PCS codes, with explanatory notes as needed Procedures in the ancillary sections 4.3 Preliminary 12/10/07 List of ancillary sections in ICD-10-PCS Six ancillary sections of ICD-10-PCS include procedures such as imaging, radiation oncology, and rehabilitation. Section value Description B Imaging C Nuclear Medicine D Radiation Oncology F Physical Rehabilitation and Diagnostic Audiology G Mental Health H Substance Abuse Treatment 4.4 ICD-10-PCS Reference Manual Preliminary 12/10/07 Imaging—Section B IMAGING follows the same conventions established in the MEDI- CAL AND SURGICAL section (see chapter 2), for the section, body system, and body part characters. However, the third and fourth characters introduce definitions not used in previous sections. u Third character defines procedure by root type, instead of root operation. u Fifth character defines contrast if used. u Sixth character is a qualifier that specifies an image taken without contrast followed by one with contrast. u Seventh character is a qualifier that is not specified in this section. Root types The IMAGING root types are defined in the following table. Value Description Definition 0 Plain Planar display of an image developed from Radiography the capture of external ionizing radiation on photographic or photoconductive plate 1 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 2 Computerized Computer reformatted digital display of Tomography (CT multiplanar images developed from the scan) capture of multiple exposures of external ionizing radiation 3 Magnetic Computer reformatted digital display of Resonance multiplanar images developed from the Imaging (MRI) capture of radio-frequency signals emitted by nuclei in a body site excited within a magnetic field 4 Ultrasonography Real time display of images of anatomy or flow information developed from the capture of reflected and attenuated high frequency sound waves Procedures in the ancillary sections 4.5 Preliminary Imaging—Section B 12/10/07 Example: X-ray of right clavicle, limited study Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Contrast Qualifier Qualifier IMAGING NON-AXIAL PLAIN CLAVICLE, NONE NONE NONE UPPER BONES RADIOGRAPHY RIGHT B P 0 4 Z Z Z Example: Fluoroscopy of renal dialysis shunt using CO2 contrast Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Contrast Qualifier Qualifier IMAGING VEINS FLUOROSCOPY DIALYSIS OTHER NONE NONE SHUNT/FISTULA CONTRAST B 5 1 W Y Z Z Example: CT of brain without contrast followed by high osmolar contrast Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Contrast Qualifier Qualifier IMAGING CENTRAL COMPUTERIZED BRAIN HIGH OSMOLAR UNENHANCED NONE NERVOUS TOMOGRAPHY AND ENHANCED B 0 2 0 0 0 Z Example: MRI of liver using Gadoteridol Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Contrast Qualifier Qualifier IMAGING HEPATOBILIARY MAGNETIC LIVER OTHER NONE NONE & PANCREAS RESONANCE CONTRAST IMAGING B F 3 5 Y Z Z Example: Ultrasound of prostate gland Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Contrast Qualifier Qualifier IMAGING MALE ULTRA- PROSTATE AND NONE NONE NONE REPRODUCTIVE SONOGRAPHY SEMINAL VESICLES B V 4 9 Z Z Z Coding exercises Using the ICD-10-PCS Tables, construct the code that accurately represents the procedure performed. 4.6 ICD-10-PCS Reference Manual Preliminary 12/10/07 Imaging—Section B Procedure Code Non-contrast CT of abdomen and pelvis BW21ZZZ Ultrasound guidance for catheter placement, left subclavian artery B342ZZZ Chest X-ray, AP/PA and lateral views BW03ZZZ Endoluminal ultrasound of gallbladder and bile ducts BF43ZZZ MRI of thyroid gland, contrast unspecified BG34YZZ Esophageal videofluoroscopy study with oral barium contrast BD11YZZ Portable X-ray study of right radius/ulna shaft, standard series BP0JZZZ Routine fetal ultrasound, second trimester twin gestation BY4DZZZ CT scan of bilateral lungs, high osmolar contrast with densitometry BB240ZZ Fluoroscopic guidance for percutaneous transluminal angioplasty (PTA) of left common B41G1ZZ femoral artery, low osmolar contrast Procedures in the ancillary sections 4.7 Preliminary 12/10/07 Nuclear Medicine—Section C NUCLEAR MEDICINE is organized like the IMAGING section (see page 4.5). The only significant difference is that the fifth charac- ter defines the radionuclide instead of the contrast material used in the procedure, as described below. u The fifth character specifies the radionuclide, the radiation source used in the procedure. Choices are applicable for the root procedure type. u The sixth and seventh characters are qualifiers, and are not specified in this section. Root types The third character classifies the procedure by root type instead of by root operation. Value Description Definition 1 Planar Nuclear Introduction of radioactive materials into Medicine Imaging the body for single plane display of images developed from the capture of radioactive emissions 2 Tomographic Introduction of radioactive materials into (Tomo) Nuclear the body for three-dimensional display of Medicine Imaging images developed from the capture of radioactive emissions 3 Positron Emission Introduction of radioactive materials into Tomography the body for three-dimensional display of (PET) images developed from the simultaneous capture, 180 degrees apart, of radioactive emissions 4 Nonimaging Introduction of radioactive materials into Nuclear Medicine the body for measurements of organ Uptake function, from the detection of radioactive emissions 4.8 ICD-10-PCS Reference Manual Preliminary 12/10/07 Nuclear Medicine—Section C Value Description Definition 5 Nonimaging Introduction of radioactive materials into Nuclear Medicine the body for the study of distribution and Probe fate of certain substances by the detection of radioactive emissions from an external source 6 Nonimaging Introduction of radioactive materials into Nuclear medicine the body for the study of body fluids and Assay blood elements, by the detection of radioactive emissions 7 Systemic Nuclear Introduction of unsealed radioactive Medicine Therapy materials into the body for treatment Example: Adenosine sestamibi (technetium) planar scan of heart muscle at rest Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Radionuclide Qualifier. Qualifier NUCLEAR HEART PLANAR MYOCARDIUM TECHNETIUM NONE NONE MEDICINE NUCLEAR 99M IMAGING C 2 1 G 1 Z Z Example: Technetium tomo scan of liver Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Radionuclide Qualifier. Qualifier NUCLEAR HEPATOBILIARY TOMO NUCLEAR LIVER TECHNETIUM NONE NONE MEDICINE AND PANCREAS IMAGING 99M C F 2 5 1 Z Z Procedures in the ancillary sections 4.9 Preliminary Nuclear Medicine—Section C 12/10/07 Coding exercises Using the ICD-10-PCS Tables, construct the code that accurately represents the procedure performed. Procedure Code Tomo scan of right and left heart, unspecified radiopharmaceutical, qualitative gated C226YZZ rest Technetium pentetate assay of kidneys, ureters, and bladder CT631ZZ Uniplanar scan of spine using technetium oxidronate, with first pass study CP151ZZ Thallous chloride tomographic scan of bilateral breasts CH22SZZ PET scan of myocardium using rubidium C23GQZZ Gallium citrate scan of head and neck, single plane imaging CW1BLZZ Xenon gas nonimaging probe of brain C050VZZ Upper GI scan, radiopharmaceutical unspecified, for gastric emptying CD15YZZ Carbon 11 PET scan of brain with quantification C030BZZ Iodinated albumin nuclear medicine assay, blood plasma volume study C763HZZ 4.10 ICD-10-PCS Reference Manual Preliminary 12/10/07 Radiation Oncology—Section D RADIATION ONCOLOGY contains the radiation procedures per- formed for cancer treatment. Character meanings are described below. u Third character defines root type, which is the basic modality. u Fifth character further specifies treatment modality. u Sixth character defines the radioactive isotope used, if applicable. u Seventh character is a qualifier, and is not specified in this section. Root type The third character defines the treatment modality as root type. Examples are BRACHYTHERAPY and STEREOTACTIC RADIOSURGERY. Four different root types are used in this section, as listed in the table below. Value Description 0 Beam Radiation 1 Brachytherapy 2 Stereotactic Radiosurgery Y Other Radiation Example: LDR Brachytherapy of cervix using Iridium 192 Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Type Body Part Modal. Qualifier Isotope Qualifier RADIATION FEMALE BRACHY- CERVIX LDR BRACHY- IRIDIUM 192 NONE ONCOLOGY REPRODUCTIVE THERAPY THERAPY D U 1 1 B 8 Z Example: Intraoperative radiation therapy (IORT) of bladder Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body Sys Root Type Body Part Modal. Qualifier Isotope Qualifier RADIATION URINARY OTHER BLADDER IORT NONE NONE ONCOLOGY SYSTEM RADIATION D T Y 2 C Z Z Procedures in the ancillary sections 4.11 Preliminary Radiation Oncology—Section D 12/10/07 Coding exercises Using the ICD-10-PCS Tables, construct the code that accurately represents the procedure performed. Procedure Code Plaque radiation of left eye, single port D8Y0FZZ 8 MeV photon beam radiation to brain D0011ZZ IORT of colon, 3 ports DDY5CZZ HDR Brachytherapy of prostate using Palladium 103 DV109BZ Electron radiation treatment of right breast, custom device DM013ZZ Hyperthermia oncology treatment of pelvic region DWY68ZZ Contact radiation of tongue D9Y57ZZ Heavy particle radiation treatment of pancreas, four risk sites DF034ZZ LDR brachytherapy to spinal cord using iodine D016B9Z Whole body Phosphorus 32 administration with risk to hematopoetic system DWY5GFZ 4.12 ICD-10-PCS Reference Manual