Just Released: ICD-9-CM Updates Increase Neoplasm Specificity

Plus, significant other changes make way for more precise diagnosis reporting.

By G.J. Verhovshek, MA, CPC

The Centers for Medicare & Medicaid Services (CMS) has released an updated ICD-9-CM code set, effective Oct. 1, 2011. The nearly 250 changes include more than a few minor descriptor revisions, but also significant code additions. Among these, the most prominent are 40 new codes for malignant neoplasms now described by location as “unspecified” (fifth digit “0”), “basal cell carcinoma” (fifth digit “1”), “squamous cell carcinoma” (fifth digit “2”), and “other specified” (fifth digit “9”). Ten “other malignant neoplasm” (four-digit) codes were deleted to make way for these new, more precise codes:

173.0                  Other malignant neoplasm of skin of lip

                  173.00                  Unspecified malignant neoplasm of skin of lip

                  173.01                  Basal cell carcinoma of skin of lip

                  173.02                  Squamous cell carcinoma of skin of lip

                  173.09                  Other specified malignant neoplasm of skin of lip

173.1                  Other malignant neoplasm of skin of eyelid, including canthus

                  173.10                  Unspecified malignant neoplasm of eyelid, including canthus

                  173.11                  Basal cell carcinoma of eyelid, including canthus

                  173.12                  Squamous cell carcinoma of eyelid, including canthus

                  173.19                  Other specified malignant neoplasm of eyelid, including canthus

173.2                  Other malignant neoplasm of skin of ear and external auditory canal

                  173.20                  Unspecified malignant neoplasm of skin of ear and external auditory canal

                  173.21                  Basal cell carcinoma of skin of ear and external auditory canal

                  173.22                  Squamous cell carcinoma of skin of ear and external auditory canal

                  173.29                  Other specified malignant neoplasm of skin of ear and external auditory canal

173.3                  Other malignant neoplasm of skin of other and unspecified parts of face

                  173.30                  Unspecified malignant neoplasm of skin of other and unspecified parts of face

                  173.31                  Basal cell carcinoma of skin of other and unspecified parts of face

                  173.32                  Squamous cell carcinoma of skin of other and unspecified parts of face

                  173.39                  Other specified malignant neoplasm of skin of other and unspecified parts of face

173.4                  Other malignant neoplasm of scalp and skin of neck

                  173.40                  Unspecified malignant neoplasm of scalp and skin of neck

                  173.41                  Basal cell carcinoma of scalp and skin of neck

                  173.42                  Squamous cell carcinoma of scalp and skin of neck

                  173.49                  Other specified malignant neoplasm of scalp and skin of neck

173.5                  Other malignant neoplasm of skin of trunk, except scrotum

                  173.50                  Unspecified malignant neoplasm of skin of trunk, except scrotum

                  173.51                  Basal cell carcinoma of skin of trunk, except scrotum

                  173.52                  Squamous cell carcinoma of skin of trunk, except scrotum

                  173.59                  Other specified malignant neoplasm of skin of trunk, except scrotum

173.6                  Other malignant neoplasm of skin of upper limb, including shoulder

                  173.60                  Unspecified malignant neoplasm of skin of upper limb, including shoulder

                  173.61                  Basal cell carcinoma of skin of upper limb, including shoulder

                  173.62                  Squamous cell carcinoma of skin of upper limb, including shoulder

                  173.69                  Other specified malignant neoplasm of skin of upper limb, including shoulder

173.7                  Other malignant neoplasm of skin of lower limb, including hip

                  173.70                  Unspecified malignant neoplasm of skin of lower limb, including hip

                  173.71                  Basal cell carcinoma of skin of lower limb, including hip

                  173.72                  Squamous cell carcinoma of skin of lower limb, including hip

                  173.79                  Other specified malignant neoplasm of skin of lower limb, including hip

173.8                  Other malignant neoplasm of other specified sites of skin

                  173.80                  Unspecified malignant neoplasm of other specified sites of skin

                  173.81                  Basal cell carcinoma of other specified sites of skin

                  173.82                  Squamous cell carcinoma of other specified sites of skin

                  173.89                  Other specified malignant neoplasm of other specified sites of skin

173.9                  Other malignant neoplasm of skin, site unspecified

                  173.90                  Unspecified malignant neoplasm of skin, site unspecified

                  173.91                  Basal cell carcinoma of skin, site unspecified

                  173.92                  Squamous cell carcinoma of skin, site unspecified

                  173.99                  Other specified malignant neoplasm of skin, site unspecified

Basal cell carcinoma and squamous cell carcinoma are the most common forms of skin cancer, but are not reportable to cancer registries. The New York State Cancer Registry requested specific codes for basal cell and squamous cell carcinoma so these cancers could be identified easily without a time-consuming review of medical records. All skin neoplasms are reported by site, with category 173.9x reserved for skin neoplasms of unspecified site.

Glaucoma Gains Low-risk and High-risk Designations

ICD-9-CM now differentiates low-risk versus high-risk open angle glaucoma, with the revision of 365.01 and addition of 365.05:

365.01                  Open angle with borderline findings, low risk

365.05                  Open angle with borderline findings, high risk

There are several types of glaucoma (primary open angle glaucoma, primary angle closure glaucoma, pigmentary glaucoma, etc.), which are caused by damage to the optic nerve and may lead to vision loss. Patients may present for treatment at different stages of the disease. The American Academy of Ophthalmology (AAO) requested the new codes to capture the stage of disease. Typically, the earlier the patient presents for treatment, the better the outcome.

Also new is a code for family history of glaucoma: V19.11 Family history of glaucoma.

glaucoma-2

Saddle Up for Improved Embolism Coding

Saddle emboli occur when a large clot lodges in an artery bifurcation, which causes blockage in both branches. Saddle emboli are the most severe type of emboli, and have a high mortality rate. They occur most commonly in the aorta, but may occur elsewhere. In recognition of this, ICD-9-CM has added several new codes to report saddle emboli in locations other than the aorta:

415.13                  Saddle embolus of pulmonary artery

444.01                  Saddle embolus of abdominal aorta

Previously, saddle emboli defaulted to the aorta.

ICD-9-CM also adds V12.55 for Personal history of pulmonary embolism and 444.09 for Other arterial embolism and thrombosis of abdominal aorta.

Pneumothorax Also Gain Precision

Spontaneous pneumothorax (collapsed lung) may be primary or secondary to another condition (for instance, cystic fibrosis). New codes were created to report the specific, various types of air leaks and pneumothorax.

512.81                  Primary spontaneous pneumothorax

512.82                  Secondary spontaneous pneumothorax

512.83                  Chronic pneumothorax

512.84                  Other air leak

512.89                  Other pneumothorax

A patient can have a postoperative air leak without significant air in the pleural space. A patient also can have a persistent air leak that is not postoperative. Previously, postoperative air leak was reported with 512.1 Iatrogenic pneumothorax. The American College of Surgeons requested the new codes to report postoperative air leak, and primary and secondary pneumothorax.

The National Center for Health Statistics (NCHS) proposed a new category of codes to report complications of infection or device malfunction with bariatric and gastric bypass surgery.

Bariatric Surgery Complications Now Recognized

Bariatric procedures for weight loss have become increasingly common in recent years, and so has the incidence of surgical complications. The National Center for Health Statistics (NCHS) proposed a new category of codes to report complications of infection or device malfunction with bariatric and gastric bypass surgery.

539.01                  Infection due to gastric band procedure

539.09                  Other complications of gastric band procedure

539.81                  Infection due to other bariatric procedure

539.89                  Other complications of other bariatric procedure

Use All Available Resources to Keep Current

The above revisions are among the more significant in the latest ICD-9-CM update, but there are many dozens of additional changes that may affect your practice. A full listing of the most recent ICD-9 changes, with full explanations, documentation tips, and more, can be found in the AAPC’s “Complete 2012 ICD-9-CM Coding Updates” (see AAPC’s website for more details). Additional ICD-9-CM changes released as subsequent addenda or errata can be found on the Centers for Disease Control and Prevention’s (CDC’s) website at www.cdc.gov/nchs/icd.htm.

Sidebar

The New York State Cancer Registry requested specific codes for basal cell and squamous cell carcinoma so these cancers could be identified easily, without a time-consuming review of medical records.

dec-clearance-sale

G.J. Verhovshek, MA, CPC, is managing editor at AAPC.

Latest posts by admin aapc (see all)

Leave a Reply

Your email address will not be published. Required fields are marked *