Health Information Management

Tip: Dual coding in CPT and ICD-10-PCS presents challenges

APCs Insider, May 9, 2014

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Some hospitals plan to dual code in both CPT® and ICD-10-PCS so they can compare data across inpatient and outpatient departments. There are several challenges for comparing data between CPT and ICD-10-PCS, however. CPT contains many combination codes that would require multiple ICD-10-PCS codes to capture the same information.
For example, CPT code 52234 (cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; small bladder tumor[s] [0.5 up to 2.0 cm]) highlights many of the risks of trying to pull equivalent data between code sets. The coder would first have to determine if the tumor was fulgurated or resected, which would result in different ICD-10-PCS root operations. If the physician treats multiple tumors, coders would need to report multiple codes that might include the same seven characters. Even after looking for more documentation and creating additional codes, ICD-10-PCS cannot capture the size of the tumors, while CPT has three options.
This tip is adapted from “Facilities consider using CPT and ICD-10-PCS to improve data collection” in the May issue of Briefings on APCs.

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