Oncology & Hematology Coding Alert

Plus: Get the latest on the proposed implementation date.

News flash: On April 9, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced a proposed rule that includes a new ICD-10 implementation date: Oct. 1, 2014.

This information about the one-year delay is in an April 9 press release, "New Health Care Law Provisions Cut Red Tape, Save Up to $4.6 Billion," at www.cms.gov/apps/media/press_releases.asp.

If the new date has you feeling motivated to step up your preparations, check out this review of coding melanoma of the scalp and neck. It reveals how corresponding ICD-9-CM and ICD-10-CM codes with similar definitions may include different diagnoses.

ICD-9-CM Code

• 172.4, Malignant melanoma of skin of scalp and neck

ICD-10-CM Codes

• C43.4, Malignant melanoma of scalp and neck
• D03.4, Melanoma in situ of scalp and neck

ICD-9-CM coding rules: ICD-9-CM instructs you to include melanocarcinoma, melanoma in situ of skin, and melanoma (skin) NOS under 172.x (Malignant melanoma of skin).

ICD-10-CM changes: The difference between your ICD-9-CM and ICD-10-CM choices for this diagnosis is that ICD-10-CM excludes melanoma in situ (D03.-) from C43.- (Malignant melanoma of skin).

For melanocarcinoma the ICD-10-CM index entry instructs you to "see melanoma." So for that diagnosis you'll choose the appropriate code from the melanoma entry and then verify your choice in the tabular listing.

Documentation: When choosing your ICD-10-CM code, you will first need to confirm that the location of the melanoma is the scalp or neck. Next you will need to determine whether the melanoma is documented as "in situ." The National Cancer Institute indicates that melanoma in situ is stage 0 melanoma (www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page2). The abnormal cells are located in the epidermis in stage 0 melanoma.

As a medical oncology coder, you're more likely to see a patient diagnosed with melanoma (not in situ) and most likely it will have metastasized. If the oncologist documents stage I or above, or indicates the melanoma has metastasized, you'll know that the melanoma is not in situ.

Coder tips: Code C43.- excludes melanoma in situ using an Excludes1 note. It indicates that the excluded diagnosis (D03.-, melanoma in situ) should never be used at the same time as the code that has the Excludes1 note (C43.-). Excludes1 is used when two conditions cannot occur together, such as a congenital form and an acquired form of the same condition.

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.