Oncology & Hematology Coding Alert

But you'll still need to look elsewhere to report renal pelvis neoplasms.

When ICD-10-CM replaces ICD-9-CM on Oct. 1, 2013, you'll be stuck reporting a lot of "unspecified" codes if your practice doesn't have its documentation ducks in a row. That's because many of the ICD-10-CM codes require more anatomic location information than ICD-9-CM codes currently do. As an example, take a look at the codes for kidney malignant neoplasms.

ICD-9-CM: Under ICD-9-CM, you should report a primary malignant kidney neoplasm using 189.0 (Malignant neoplasm of kidney except pelvis). As the code definition specifies, 189.0 is not appropriate for a pelvis neoplasm. For that diagnosis, you should instead look to 189.1 (Malignant neoplasm of renal pelvis).

ICD-10-CM: The main difference between ICD-9-CM and ICD-10-CM is that the latter references right, left, and unspecified kidney:

• C64.1, Malignant neoplasm of right kidney, except renal pelvis
• C64.2, Malignant neoplasm of left kidney, except renal pelvis
• C64.9, Malignant neoplasm of unspecified kidney, except renal pelvis.

An important similarity between the two code sets is that the C64.- range excludes renal pelvis neoplasms, just as 189.0 does. For renal pelvis neoplasm diagnoses, consider these codes:

• C65.1, Malignant neoplasm of right renal pelvis
• C65.2, Malignant neoplasm of left renal pelvis
• C65.9, Malignant neoplasm of unspecified renal pelvis.

Coder tips: As part of your ICD-10-CM preparation plan, educate your providers to specify in their progress notes whether the kidney neoplasm is on the right or left side. That information simplifies your task of choosing the most specific code for the patient.

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, 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.