Cracking the Code
Diagnostic vs Therapeutic Procedures
The main factor when considering whether a procedure is diagnostic or therapeutic is to determine the objective of the procedure. If the main objective is to establish a diagnosis for the patient prior to starting any kind of treatment, then it is considered to be a diagnostic procedure. If a diagnosis is already established and a procedure is completed in order to eradicate a problem, then it is considered to be a therapeutic procedure. For drainage root operations, the ICD-10-PCS guidelines state that if a diagnostic procedure is followed by a more definitive procedure (therapeutic) then both the diagnostic and more definitive treatment are coded.
The provider’s documentation supports reporting of BOTH diagnostic and therapeutic procedures. So it is appropriate for coders to assign ICD-10-PCS codes for both procedures to fully capture the entire picture for this encounter.
Q: A patient comes in for a biopsy of their left pleural cavity via thoracentesis. During the same encounter, the physician also performs a therapeutic thoracentesis from the right side of the patient’s chest.
A: 0W9B3ZX, drainage of left pleural cavity, percutaneous, diagnostic
0W993ZX, drainage of right pleural cavity, percutaneous
0W993ZX, drainage of right pleural cavity, percutaneous
Reference: ICD-10-PCS Official Guidelines for Coding and Reporting FY 2022 Section B3.4b: biopsy followed by more definitive treatment