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 second in 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 last three Ancillary sections. The side bar at the right displays all six of the Ancillary sections; this article will focus on sections F-H.

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

Physical Rehabilitation and Diagnostic Audiology: Section Value F

The Physical Rehabilitation and Diagnostic Audiology section consists of 1,380 codes and classifies procedures by treatment, assessment, fitting(s), and caregiver training. The Physical Rehabilitation section represents physical therapy, occupational therapy, and speech-language pathology procedures. This section’s first character value is F and the second character is a section qualifier which specifies the procedures as either Rehabilitation or Diagnostic Audiology. The third character, root type, specifies the general procedure. The fourth character indicates the body system or body region studied which can be combined where applicable. The fifth character, type qualifier, further specifies the type of procedure, such as a precise test or method employed. The sixth character specifies the equipment used if applicable for the procedure. The seventh character is a qualifier that is not specified in this section and has no value.

Character 3—Root Type for Section Value F

Section value F includes 14 root types. The ICD-10-PCS Reference Manual provides the following root type definitions:

• Speech Assessment: Measurement of speech and related functions
• Motor and/or Nerve Function Assessment: Measurement of motor, nerve, and related functions
• Activities of Daily Living Assessment: Measurement of functional level for activities of daily living
• Hearing Assessment: Measurement of hearing and related functions
• Hearing Aid Assessment: Measurement of the appropriateness and/or effectiveness of a hearing device
• Vestibular Assessment: Measurement of the vestibular system and related functions
• Speech Treatment: Application of techniques to improve, augment, or compensate for speech and related functional impairment
• Motor Treatment: Exercise or activities to increase or facilitate motor function
• Activities of Daily Living Treatment: Exercise or activities to facilitate functional competence for activities of daily living
• Hearing Treatment: Application of techniques to improve, augment, or compensate for hearing and related functional impairment
• Cochlear Implant Treatment: Application of techniques to improve the communication abilities of individuals with a cochlear implant
• Vestibular Treatment: Application of techniques to improve, augment, or compensate for vestibular and related functional impairment
• Device Fitting: Fitting of a device designed to facilitate or support achievement of a higher level of function
• Caregiver Training: Training in activities to support optimal level of function for patients

Character 5—Type Qualifier for Section Value F

All the Physical Rehabilitation and Diagnostic Audiology root types include type qualifiers to further specify the procedure type. For example, activities of daily living treatment includes type qualifiers such as wound management, bathing/showering techniques, dressing techniques, and feeding/eating activities.

Character 6—Equipment for Section Value F

In ICD-10-PCS, equipment used to assist in the performance of the procedure is not coded in PCS. The only exception to this rule occurs in the Rehabilitation and Diagnostic Audiology section, where the sixth character is specified as equipment. The sixth character values in this section are used to capture information about the machine, physical aid, or other equipment used to assist in performing the procedure.

Mental Health: Section Value G

The Mental Health section consists of 30 codes and classifies procedures by crisis intervention, family psychotherapy, and biofeedback. The first character for the mental health section is G. Since the body system doesn’t apply in this section, the second character is assigned the value Z, none. The third character, root type, describes the type of mental health procedure and character four, type qualifier, further specifies the root type. The fifth, sixth, and seventh characters are not specified in the Mental Health section and are assigned the value Z, none.

Character 3—Root Type for Section Value G

The Mental Health section includes 12 root types. The ICD-10-PCS Reference Manual gives the following root type definitions:

• Psychological Tests: The administration and interpretation of standardized psychological tests and measurement instruments for the assessment of psychological function
• Crisis Intervention: Treatment of a traumatized, acutely disturbed, or distressed individual for the purpose of short-term stabilization
• Medication Management: Monitoring and adjusting the use of medications for the treatment of a mental health disorder
• Individual Psychotherapy: Treatment of an individual with a mental health disorder by behavioral, cognitive, psychoanalytic, psychodynamic, or psychophysiological means to improve functioning or well-being
• Counseling: The application of psychological methods to treat an individual with normal developmental issues and psychological problems in order to increase function, improve well-being, alleviate distress or maladjustment, or resolve crises
• Family Psychotherapy: Treatment that includes one or more family members of an individual with a mental health disorder by behavioral, cognitive, psychoanalytic, psychodynamic, or psychophysiological means to improve functioning or well-being
• Electroconvulsive Therapy: The application of controlled electrical voltages to treat a mental health disorder
• Biofeedback: Provision of information from the monitoring and regulating of physiological processes in conjunction with cognitive-behavioral techniques to improve patient functioning or well-being. Biofeedback procedure examples include electroencephalography, blood pressure, skin temperature or peripheral blood flow, electrocardiogram, electrooculogram, electromyogram, respirometry or capnometry, galvanic skin response GSR/electrodermal response, perineometry to monitor/regulate bowel/bladder activity, and electrogastrogram to monitor/regulate gastric motility.
• Hypnosis: Induction of a state of heightened suggestibility by auditory, visual, and tactile techniques to elicit an emotional or behavioral response
• Narcosynthesis: Administration of intravenous barbiturates in order to release suppressed or repressed thoughts
• Group Therapy: Treatment of two or more individuals with a mental health disorder by behavioral, cognitive, psychoanalytic, psychodynamic, or psychophysiological means to improve functioning or well-being
• Light Therapy: Application of specialized light treatments to improve functioning or well-being

Character 4—Type Qualifier for Section Value G

Six of the 12 Mental Health section root types include type qualifiers to further specify the mental health procedure. For example, electroconvulsive therapy is further classified by unilateral-single seizure, unilateral-multiple seizure, bilateral single-seizure, bilateral-multiple seizure, and other electroconvulsive therapy.

Substance Abuse Treatment: Section Value H

The Substance Abuse Treatment section consists of 59 codes and classifies treatment by detoxification, counseling, and pharmacotherapy. The first character for the substance abuse section is H. Similar to the Mental Health section, the second character, body system, doesn’t apply for this section and is assigned the value Z, none. The third character, root type, describes the type of substance abuse treatment and character four, type qualifier, further specifies the root type. The fifth, sixth, and seventh characters are not specified in the Mental Health section and are not specified in the Substance Abuse Treatment section and are assigned the value Z, none.

Character 3—Root Types for Section Value H

The Substance Abuse Treatment section includes seven root types and the ICD-10-PCS Reference Manual provides the following root type definitions:

• Detoxification Services: Detoxification from alcohol and/or drugs
• Individual Counseling: The application of psychological methods to treat an individual with addictive behavior
• Group Counseling: The application of psychological methods to treat two or more individuals with addictive behavior
• Individual Psychotherapy: Treatment of an individual with a mental health disorder by behavioral, cognitive, psychoanalytic, psychodynamic or psychophysiological means to improve functioning or well-being
• Family Counseling: The application of psychological methods that includes one or more family members to treat an individual with addictive behavior
• Medication Management: Monitoring and adjusting the use of replacement medications for the treatment of addiction
• Pharmacotherapy: The use of replacement medications for the treatment of addiction

Character 4—Type Qualifier for Section Value H

Six of the seven root types in this section include type qualifiers to further specify the substance abuse treatment. For example, individual counseling is further classified by cognitive, behavioral, cognitive-behavioral, 12-step, interpersonal, vocational, psychoeducation, motivational enhancement, confrontational, continuing care, spiritual, and pre/post-test infectious disease.

Resources

Barta, Ann et al. 2014 ICD-10-PCS Coder Training Manual: Instructor’s Edition. Chicago, IL: AHIMA Press, 2013.

Centers for Medicare and Medicaid Services. “2015 Code Tables and Index.” 2014. http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html.

Centers for Medicare and Medicaid Services. “2015 ICD-10-PCS Reference Manual.” 2014. http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html.

Centers for Medicare and Medicaid Services. “2015 ICD-10-PCS Official Guidelines for Coding and Reporting.” 2014. http://www.cms.gov/Medicare/Coding/ICD10/Downloads/2015-PCS-guidelines.pdf.

Karen Kostick (Karen.Kostick@nuance.com) is technical business analyst, CLU and CAC content, and Gina Sanvik (Gina.Sanvik@nuance.com) is manager, CLU and CAC content, at Nuance Communications, Inc.