Catch Up on Hematology and Oncology in ICD-10-CM
Know your guidance to maintain compliant coding.
By Elizabeth Wernet, CPC, CHONC
ICD-10-CM and the ICD-10-CM Official Guidelines for Coding and Reporting 2014 bring new guidance for hematology and oncology coders. Take the time now to become familiar and fully understand the official guidelines to ensure later that your coding is accurate, consistent, and compliant—the ultimate goal.
Concentrate on the Neoplasm Chapter, for Now
Hematology and oncology coders generally code from chapters 2, Neoplasms (140-239) and 4, Diseases of Blood and Blood Forming Organs (280-289) in the ICD-9-CM guidelines. In the ICD-10-CM guidelines, chapter 3, Diseases of blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) is reserved for future guideline expansion, so let’s focus on the ICD-10-CM guidelines in chapter 2, Neoplasms (C00-D49), for the time being.
Neoplasms with Pregnancy
Chapter 2 in the ICD-10-CM guidelines follows many of the same guidelines found in ICD-9-CM, with newly added guidance for complications and sequencing of neoplasms.
For example, new guideline I.C.2.l.3, Malignant neoplasm in a pregnant patient, states, “When a pregnant woman has a malignant neoplasm, a code from subcategory O9A.1-, Malignant neoplasm complicating pregnancy, childbirth and the puerperium, should be sequenced first, followed by the appropriate code from Chapter 2 to indicate the type of neoplasm.”
If a pregnant patient in her second trimester, 14 weeks gestation, has a malignant neoplasm of temporal lobe, you’ll need three codes: O9A.112 Malignant neoplasm complicating pregnancy, second trimester followed by the appropriate neoplasm code, C71.2 Malignant neoplasm of temporal lobe, and Z3A.14 14 weeks gestation of pregnancy. Note that the pregnancy code has sequencing priority.
Complication Associated with Neoplasm
New guideline I.C.2.l.4, Encounter for complication associated with a neoplasm, states, “When an encounter is for management of a complication associated with a neoplasm, such as dehydration, and the treatment is only for the complication, the complication is coded first, followed by the appropriate code(s) for the neoplasm.”
For example, if the patient presents for treatment of dehydration due to primary thoracic esophageal cancer and not for treatment of the malignancy, proper coding would be E86.0 Dehydration followed by C15.4 Malignant neoplasm of middle third of esophagus. In other words: If the encounter is for treatment of the complication (hydration), and not for the neoplasm, code first what is being treated, and then the neoplasm.
The exception to this guideline is anemia. When the admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis, followed by D63.0 Anemia in neoplastic disease. If the encounter is for management of anemia due to colon cancer, code the malignancy first, then the anemia (e.g., C18.9 Malignant neoplasm of colon, unspecified, D63.0).
Surgical Complications of Neoplasm
Guideline I.C.2.l.5, Complication from surgical procedure for treatment of a neoplasm, states, “When an encounter is for treatment of a complication resulting from a surgical procedure performed for the treatment of the neoplasm, designate the complication as the principal/first-listed diagnosis. See guideline regarding the coding of a current malignancy versus personal history to determine if the code for the neoplasm should also be assigned.”
For example, if you are coding an encounter for a patient with postsurgical blind loop syndrome after gastric resection for gastric antrum (pyloric) cancer, and the cancer is not resolved, code the complication followed by the code for the neoplasm (e.g., K91.2 Postsurgical malabsorption, not elsewhere classified, C16.3 Malignant neoplasm of pyloric antrum).
Fracture and Neoplasm
Per I.C.2.l.6, Pathologic fracture due to neoplasm, if the treatment is for fracture, select the appropriate code from subcategory M84.5- Pathological fracture in neoplastic disease, followed by the code for the neoplasm. If the focus of treatment is the neoplasm with an associated pathological fracture, sequence the neoplasm first, followed by a code from M84.5-.
For example, a patient’s treatment is for the pathological fracture of vertebrae due to malignancy of prostate. Code M84.58xx Pathologic fracture in neoplastic disease, other specified site for the vertebrae (seven digits are required for this subcategory; here, we have a placeholder “x” and need the seventh digit to denote the episode of care), followed by neoplasm code C61 Malignant neoplasm of prostate. Reverse the sequencing to C61, M84.58xx if the focus of treatment was the neoplasm.
Current vs. History of Malignancy
I.C.2.m, Current malignancy versus personal history of malignancy, provides familiar guidance for most hematology and oncology coders:
“When a primary malignancy has been excised but further treatment, such as an additional surgery for the malignancy, radiation therapy or chemotherapy is directed to that site, the primary malignancy code should be used until treatment is completed. Meaning that if a patient is receiving active treatment following surgery code the cancer as current. An example such as a patient presenting for medication management and to discuss further treatment following craniectomy for primary brain cancer, we code active cancer as the patient is getting current, active treatment. C71.9. Malignant neoplasm of brain, unspecified.
“When a primary malignancy has been previously excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is no evidence of any existing primary malignancy, a code from category Z85.-, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy.”
See Section I.C.21. Factors influencing health status and contact with health services, History (of).
If, after surgery, there is no active treatment and no evidence of remaining malignancy, use the “history of” neoplasm codes. For example, to report the follow-up visit after craniectomy with no treatment, no evidence of current malignancy, report code Z85.841 Personal history of malignant neoplasm of brain.
Neoplasms in Remission
I.C.2.n, Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission versus personal history, states:
“The categories for leukemia, and category C90, Multiple myeloma and malignant plasma cell neoplasms, have codes indicating whether or not the leukemia has achieved remission. There are also codes Z85.8, Personal history of leukemia, and Z85.79, Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues. If the documentation is unclear, as to whether the leukemia has achieved remission, the provider should be queried.”
See section I.C.21. Factors influencing health status and contact with health services, History (of).
For example, consider subcategory C91.4- Hairy cell leukemia. The fifth digit requirement differentiates whether the condition has achieved remission or relapse:
- C91.40 Hairy cell leukemia not having achieved remission [hairy cell leukemia with failed remission, hairy cell leukemia NOS]
- C91.41 Hairy cell leukemia, in remission
- C91.42 Hairy cell leukemia, in relapse
ICD-10-CM has an expanded code set for leukemia, so be sure to familiarize yourself with the added specificity required for proper code assignment.
“See Section” Guidelines
Three more new guidelines are pretty straightforward:
I.C.2.o, Aftercare following surgery for neoplasm, refers you to “See Section I.C.21, Factors influencing health status and contact with health services, Aftercare.”
I.C.2.p, Follow-up care for completed treatment of malignancy, refers you to “See Section I.C.21, Factors influencing health status and contact with health services, Follow-up.”
I.C.2.q, Prophylactic organ removal for prevention of malignancy, directs you to “I.C.21, Factors influencing health status and contact with health services, prophylactic organ removal.”
Guidelines Matter, but Payers May Differ
Regardless of what the guidelines say, some commercial payers want certain codes reported as primary. A common example involves V58.11 Encounter for antineoplastic chemotherapy and V58.12 Encounter for antineoplastic immunotherapy. In ICD-9-CM, these codes are designated as primary, but many payers require you to code the neoplasm as primary, followed by V58.11 and/or V58.12.
When coding, or taking the Certified Hematology and Oncology Coder (CHONC™) exam, you must be clear on the differences of the official guidelines, Medicare guidelines, and payer preference.
Resources for Hematology &
Oncology Coders and ICD-10-CM
The ICD-9-CM and ICD-10-CM guidelines can be found on the CMS website, as well as the Centers for Disease Control and Prevention’s website. If you have access to an ICD-9-CM codebook or ICD-10-CM draft, the Official Guidelines are printed in the beginning of the book. I recommend printing chapter 2 guidelines and spending a few minutes each day to learn them. The AHA Coding Clinic is also putting out official guidance and tips for ICD-10-CM.
The AAPC website has a “code converter” tool, the ICD-10 Code Translator, which is very helpful. The tool allows you to input an ICD-9 code and convert it to the corresponding ICD-10 code(s), or vice versa. For example, ICD-9-CM 199.1 Other malignant neoplasm without specification of site; other (primary) maps to ICD-10-CM C80.1 Malignant (primary) neoplasm, unspecified.
Similar tools are included in AAPC Coder, Encoder Pro, and in some coding books (e.g., OptumInsight ICD-10-CM mapping tool) to provide a “crossover” from one code set to the other:
V13.89 Personal history of other specified diseases
Z86.000 Personal history of in-situ neoplasm of breast
Z86.001 Personal history of in-situ neoplasm of cervix uteri
Z86.008 Personal history of in-situ neoplasm of other site
Z86.012 Personal history of benign carcinoid tumor
Z86.018 Personal history of other benign neoplasm
Z86.03 Personal history of neoplasm of uncertain behavior
Z87.430 Personal history of prostatic dysplasia
Z87.438 Personal history of other diseases of male genital organs
Z87.898 Personal history of other specified conditions
Elizabeth Wernet, CPC, CHONC, codes for Healthcare Billing Resources, Inc. in Minnesota. She is a member of the St. Paul, Minn., local chapter.