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Chapter 24 Imaging, Nuclear Medicine and Radiation Oncology

International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach 2012 Edition. Chapter 24 Imaging, Nuclear Medicine and Radiation Oncology. Imaging, Nuclear Medicine and Radiation Oncology. B - Imaging C - Nuclear Medicine

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Chapter 24 Imaging, Nuclear Medicine and Radiation Oncology

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  1. International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS): An Applied Approach2012 Edition Chapter 24 Imaging, Nuclear Medicine and Radiation Oncology

  2. Imaging, Nuclear Medicine and Radiation Oncology • B - Imaging • C - Nuclear Medicine • D - Radiation Oncology

  3. Types of Procedures • Radiology studies – plain films, computerized tomography and magnetic resonance imaging • Nuclear medicine uptake tests • Nuclear medicine systemic treatments • Brachytherapy • Stereotactic radiosurgery

  4. Character Definition for Imaging • 1- Section (always B) • 2 – Body System • 3 – Root Type • 4 - Body Part • 5 – Contrast • 6 - Qualifier • 7 - Qualifier

  5. Body Systems for Imaging • Body Systems – Similar to the Medical and Surgical section -Exceptions • Axial and non-axial skeleton vs. traditional axial and appendicular • Body system for fetus and obstetrical imaging

  6. Root Types • Plain Radiography • Fluoroscopy • Computerized Tomography (CT) • Magnetic Resonance Imaging (MRI) • Ultrasonography

  7. Imaging Guidance • Coded separately in this section -Qualifier Value A - Guidance • Fluoroscopy • Ultrasound

  8. X-rays • Plain radiography -Bone x-rays -Mammography

  9. Cardiac Catheterization • Catheterization Procedures -Cardiac catheterization – series of fluoroscopic images after contrast -Catheter tip positioned in the vessels requiring imaging -Oxygen sampling and pressure measurements also • Catheterization is the approach, not the procedure -Root operation Measurement in Section 4 -Left ventriculograms, interventions, via real-time fluoroscopy mages

  10. Fluoroscopy • Coronary angiography -Fluoroscopy by body part – number and type of arteries • Ventriculography -Fluoroscopy with body part value for the side of the heart

  11. Cardiac Procedures • Interventions coded in Medical and Surgical section -See chapter 11 • Multiple codes -Measurement -Fluoroscopy -Interventions

  12. Body Parts in Imaging • Mirror the Medical and Surgical section • See code tables

  13. Contrast • High osmolar • Low osmolar -See Quick guide to Contrast Media -HCPCS annotated version • Q codes • list product names • High vs. low osmolar

  14. Qualifiers-6th character • Intravascular optical coherence or Optical Coherence Tomography (OCT) -Imaging to help identify plaques • Unenhanced and Enhanced -Without and with Contrast • Laser – used with 7th character qualifier Intraoperative -Describes laser guided intraoperative fluoroscopy

  15. Qualifiers – 7th character • Specific location -Intravascular -Transesophageal • Bone ultrasound -Densitometry study • Guidance • See Table 24.5

  16. Character Definition for Nuclear Medicine • 1- Section (always C) • 2 – Body System • 3 – Root Type • 4 - Body Part • 5 – Radionuclide • 6 - Qualifier (always Z) • 7 – Qualifier (always Z)

  17. Nuclear Medicine - Diagnostic • Diagnostic – unstable radioactive elements become radionuclides – -ingested, injected or infused -Decays and gamma photon is released -Detected by gamma camera -Creates recordable image

  18. Nuclear Medicine - Therapeutic • Radioactive beta particles • Kill specific targeted cells • Root Type - Systemic Nuclear Medicine Therapy

  19. Root Types • Nonimaging Nuclear Medicine Assay • Nonimaging Nuclear Medicine Probe • Nonimaging Nuclear Medicine Uptake • Planar Nuclear Medicine Imaging • Positron Emission Tomography (PET) • Systemic Nuclear Medicine Therapy • Tomographic Nuclear Medicine

  20. Body Parts • As in Medical and Surgical • Condensed version • See the Code tables

  21. Radionuclides • Bound to a marker • Tracers give off gamma rays or positrons • Help determine function or presence of disease • See Table 24.8

  22. Character Definition for Radiation Oncology • 1- Section (always D) • 2 – Body System • 3 – Modality • 4 - Treatment Site • 5 – Modality Qualifier • 6 - Isotope • 7 – Qualifier

  23. Radiation Oncology • Use of various doses of radiation • Particular schedule • To treat and kill cancer cells • Sparing normal tissue • Various modalities based on type of tumor and location

  24. Body Systems • Similar to that of the Medical and Surgical section -See Table 24.9

  25. Modalities • Beam Radiation • Brachytherapy • Stereotactic radiosurgery • Other radiation

  26. Treatment Site • Mirror the body parts within the Medical and Surgical section • Condensed version

  27. Modality Qualifiers • Treatment modalities chosen to maximize the effect of the radiation • Minimize the damage to normal tissue • Variations in modality delivery -E.g. high or low dose rate, with whole body hyperthermia, LITT

  28. Hyperthermia • Treat temperature imbalance -Extracorporeal Therapies • Adjunct radiation treatment -Modality qualifier

  29. Isotope and Qualifiers • Isotope -See Table 24.12 • Qualifiers -Intraoperative – -Intraoperative electron beam therapy (IOEBT) -Surgeon removes as much of tumor as possible -Radiation Oncologist uses electron beam

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