October 12, 2009

Coding for Radiation Therapy
For The Record
Vol. 21 No. 19 P. 28

Radiation therapy (ICD-9-CM code 92.29) is a type of cancer treatment that uses high-energy x-ray beams to destroy cancer cells. Also called radiotherapy or x-ray therapy, radiation therapy uses ionizing radiation to destroy the genetic material in a cell, stopping it from growing and dividing.

The most common type is external beam radiation therapy, which involves directing high-energy beams to an exact point in a patient’s body. Cancerous cells are destroyed, but healthy cells are left virtually untouched. This therapy is usually given in the outpatient setting. A form of external radiation that is given during surgery is called intraoperative electron radiation therapy (92.41). Energy sources for external radiation therapy include x-rays, gamma rays, particle beams, and proton beam therapy.

Internal radiation therapy (92.27) involves an implant, such as a thin wire, catheter, ribbon, capsule, or seed, to place the radiation close to the malignancy. Also called brachytherapy, the implant is inserted directly into the body and may require an inpatient stay. Energy sources for internal radiation include iodine 125 and 131, strontium 89, phosphorus, palladium, cesium, iridium, phosphate, and cobalt.

Stereotactic radiosurgery (gamma knife radiosurgery) is a nonoperating room procedure using a large radiation dose to destroy tumor cells in the brain. In this procedure, a stereotactic head frame is placed on the patient, who then undergoes a CT or MRI exam to target and define the areas for irradiation.

Another form of radiosurgery is CyberKnife. It’s similar to gamma knife surgery, but a helmet with multiple holes is placed on a patient and radiation beams are sent through the holes. Stereotactic radiosurgery is classified to code 92.3, with a fourth-digit subcategory necessary to identify the specific type. Code 93.59 is also assigned to show the stereotactic head frame application.

ICD-9-CM Coding Guidelines Related to Radiotherapy
Admit for radiotherapy is classified to code V58.0, which will be sequenced as the principal diagnosis.

The following are common sequencing guidelines pertaining to radiotherapy:

• When a patient is admitted solely for the purpose of radiotherapy for malignancy, assign code V58.0 as the principal diagnosis (Medicare severity diagnosis-related group [MS-DRG] 849).

• When a patient is admitted for radioactive iodine therapy, the code for the condition should be sequenced as the principal diagnosis. The MS-DRG assignment depends on the specified condition.

• When a patient is admitted for the placement of radioactive implants, assign the malignancy as the principal diagnosis. (MS-DRG assignment depends on specified malignancy.) Radioactive implants should not be confused with radiotherapy treatment.

• When a patient is admitted for the sole purpose of radiotherapy and develops complications after admission, the principal diagnosis is admit for radiotherapy followed by any codes for the complications.

• When the admission is for treating anemia or dehydration due to radiotherapy, the anemia or dehydration will be sequenced as the principal diagnosis.

• When the admission is to determine the extent of the malignancy (staging), the malignancy will be sequenced as the principal diagnosis even if radiotherapy is administered.

• When the admission involves surgical removal of a malignancy, the malignancy will be sequenced as the principal diagnosis even if radiotherapy is administered.

If a patient receives more than one therapy (radiotherapy, chemotherapy, or immunotherapy) during the same admission, more than one of these codes may be assigned in any sequence. However, radiotherapy does not meet admission criteria for some quality improvement organizations. Each individual hospital may have their own internal policies regarding this issue.

Coding and sequencing for radiation therapy are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.