Disease of the Breast
When we think about diseases of the breast, most of us think about breast cancer and - even more so - we think about females and breast cancer.
In the current language of ICD-9-CM, reporting breast cancer for females falls under category 174 with the fourth character indicating where on the breast the disease has invaded. For reporting breast cancer in males we are given two choices with ICD-9-CM: 175.0 Malignant neoplasm of male breast; nipple and areola or 175.9 Malignant neoplasm of male breast; other and unspecified. As we move forward into ICD-10-CM the reporting possibilities change. For both the male and female breast cancer patient we need to know if the cancer is in the right breast, left breast, or both. As an example, a female patient with breast cancer of the central portion of her right and left breast would be reported today with 174.1; with ICD-10-CM this is reported with C50.111 Malignant neoplasm of central portion of right female breast and C50.112 Malignant neoplasm of central portion of left female breast. The same specificity is there for breast cancer in males. If your provider is documenting breast cancer of the male breast then check the documentation to make sure you have sufficient information to report the condition completely in ICD-10-CM. Some examples of what you would report for male breast cancer would be: C50.321 Malignant neoplasm of lower-inner quadrant of right male breast and C50.822 Malignant neoplasm of overlapping sites of left male breast. With all codes in the C50 category (Malignant neoplasm of breast) there is an instructional note to also report the estrogen receptor status, also (Z17.0 Estrogen receptor positive status or Z17.1 Estrogen receptor negative status) if known.
Take a good look at your documentation now to be sure location and laterality are documented in order to transition into ICD-10-CM for breast cancer coding, taking into account that it may become necessary to report two codes as shown in the example above.
IN THE NEWS
The 2013 ICD-10-CM code set has been released. CMS has also updated the ICD-10-CM Duplicate Code Numbers file, which contains 39 codes that exist in both ICD-9-CM and ICD-10-CM, but with different descriptors. The 2013 General Equivalence Mappings and Reimbursement Mappings are also released for 2013 and will be on this same page.
CHIEF COMPLAINT: Abdominal pain.
HISTORY OF PRESENT ILLNESS: This is a 71-year-old female patient who presents to the emergency department with sudden, severe abdominal pain in the left lower quadrant. She has had no nausea and vomiting, but has had bright red blood per rectum, and melena.
ALLERGIES: SHE IS ALLERGIC OR SENSITIVE TO MACRODANTIN.
SOCIAL HISTORY: She does not drink or smoke.
REVIEW OF SYSTEMS: Otherwise negative for any chest pains or shortness of breath.
GENERAL: The patient is an elderly thin white female, very pleasant, in no acute distress.
VITAL SIGNS: Her temperature is 100.3. Other vital signs are all stable, within normal limits.
HEART: Regular rate and rhythm.
ABDOMEN: Generally nondistended and soft. She is focally tender in the left lower quadrant to deep palpation with a palpable fullness or mass and focally tender, but no rebound tenderness. There is no CVA or flank tenderness, although some very minimal left flank tenderness.
EXTREMITIES: Grossly and neurovascularly intact.
LABORATORY VALUES: CBC indicates leukocytosis.
IMPRESSION AND PLAN: Sigmoid diverticulitis with bleeding. I would recommend a repeat stat CT scan of the abdomen and pelvis and keep the patient nothing by mouth. Dr. Y in Colorectal Surgery called for consult.
ICD-10-CM Codes: K57.33 Diverticulitis of large intestine without perforation or abscess with bleeding
Rationale: In ICD-10-CM the codes for diverticulitis are broken down by site (small intestine, large intestine, or both small and large intestine) as well as any complications (perforation or abscess, and bleeding). In the above scenario, the patient has diverticulitis of the sigmoid colon (part of the large intestine) with bleeding. Common signs and symptoms of sigmoid diverticulitis include left lower quadrant pain, fever, and leukocytosis (elevated white blood cell count); therefore these conditions would not be coded separately.
ICD-10 Implementation Strategies
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
Planning Your Budget
Budget management will be crucial for ICD-10 implementation for most practices. Implementation costs will fall under four main categories: information systems, auditing and monitoring, education and training, and staffing and overtime costs. If new (or upgraded) hardware and software are necessary, information systems will be the largest part of the ICD-10 budget. It will be important to discuss with your internal IT department (if you have one) or your vendors what exactly will be needed for your practice to implement ICD-10. The second biggest expense would then be education and training as this will be needed by all staff in some manner. A thorough check of your needs must be performed in order to make sure you don’t get left short when it comes to implementing ICD-10.
ICD-10 Health Plan Office Changes
Interested in seeing how ICD-10 will affect health plans? AAPC has developed a floor plan for health plans that shows just that. Check it out and see how the transition to ICD-10 will affect every health plan department.