Coding and Billing
HCT Diagnosis and Procedure codes (International Classification of Diseases (ICD) codes and Current Procedural Terminology (CPT) codes) document diagnoses and treatment for coverage and payment purposes. Learn which codes to use and when to use them.
ICD-10-PCS Procedure Codes
View a complete list of ICD-10-PCS
Procedure Codes (PDF). This crosswalk resource maps ICD-9-CM HCT covered procedure codes to ICD-10-PCS procedure codes.
New Donor Source Codes Available October 1, 2016
Prior to ICD-10 implementation transplant centers used ICD-9 codes to specify the donor source for allogeneic transplants when ICD-10 was implemented no equivalent codes were available. Through our advocacy work with Centers for Medicare and Medicaid Services (CMS), we’ve been able to get donor source codes added to the ICD-10-PCS codes.
You will now see the 7th digit, the qualifier digit, showing options to differentiate among types of donors for HCT (donor codes are different for DLI).
- 0, Autologous
- 2, Allogeneic, Related
- 3, Allogeneic, Unrelated
- 4, Allogeneic, Unspecified (only use if you don’t know whether the donor cells were related or unrelated)
Several codes from 2016 remain, making it confusing, so make sure you are coding to the greatest level of specificity paying close attention to the qualifier (7th digit) selected to indicate the specific donor type. It is very important for
transplant centers to report donor source codes so CMS understands the mix of donors used in transplants.
Commonly Used ICD-10-PCS Codes
These codes are a subset of the HCT and DLI codes, and are the most common codes you’ll use. Please refer to your 2017 ICD-10-PCS book to ensure complete and accurate coding or download the ICD-10-PCS manual. For boost, use the codes below for HCT as applicable to the method and cells used in the boost.
ICD-10-CM Diagnosis Codes
View a complete list of ICD-10-CM Diagnosis Codes (XLSX). This crosswalk resources maps ICD-9-CM
codes for covered transplant indications to the most appropriate ICD-10-CM codes.
Use these resources to learn about CPT codes for HCT.
- CPT Codes for HCT (PDF): Overview of CPT codes for HCT and when to use them, published by the ASBMT.
- HCT: How CPT Codes are Reported (PDF): CPT® Assistant. American Medical Association, October
Which Codes to Use and When
For Inpatient HCT – Use ICD-10 CM/PCS Codes
Report the patient’s diagnoses and the specific treatments provided using ICD-10 CM/PCS diagnosis and procedure codes.
Clinicians must report all diagnosis and procedure codes that occurred in conjunction with the procedure in the inpatient setting, regardless of whether they were associated with the actual “transplant procedure” or not. Documentation of the infusion procedure must be included in the hospital stay medical record because it serves as verification that the transplant or infusion of cells occurred, and documentation allows the facility to report the ICD-10-PCS procedure code for HCT. This same documentation also supports the CPT codes, which are required for, and the basis of, physician billing.
Outpatient HCT – Use Both ICD and CPT Codes
Use ICD-10 CM diagnoses and CPT procedure codes to document diagnoses and treatment.