Oncology & Hematology Coding Alert

Specify site and check complications to get to the right code.

ICD-10-CM demands more specificity for colonic polyp coding. Beware, not all colonic polyps are benign. 

Heads up: You can save your claims by distinguishing between the non-neoplastic and neoplastic polyps. Check the pathology report and that documentation of the treating physician matches the results before you look for the right code. Another specification you need is which part of the intestine are the polyps located. 

Make note of the following tips to be able to make your way to accurate diagnosis coding for colonic polyps. “It is important that the two sources of documentation match the confirmed result,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement and Advisory Services, Altegra Health, Inc. “If they do not, you should query the treating physician for clarification before assigning the ICD code in either version.”

Specify Region for Non-neoplastic Colonic Polyps

Look out for the part of the colon where the polyps are located. This will guide you to the right code in ICD-10-CM.

Hyperplastic polyps: Although they are not neoplasms, hyperplastic polyps in the colon most often occur in the rectal region, and you usually report them in ICD-9-CM with 211.4 (Benign neoplasm of rectum and anal canal). 

ICD-10-CM: As of Oct. 1, 2015, you will have to specify the exact location with D12.7 (Benign neoplasm of rectosigmoid junction), D12.8 (Benign neoplasm of rectum), or D12.9 (Benign neoplasm of anus and anal canal).

Difference: You should currently report hyperplastic polyps found in any other region with 211.3 (Benign neoplasm of colon), but you will report them in ICD-10-CM with more specificity by choosing from among the subcategory D12.x with the fourth digit (0-6) specifying the more exact location. 

The ICD-9 code 211.3 maps to the following ICD-10-CM options:

• D12.0, Benign neoplasm of cecum
  
• D12.1, Benign neoplasm of appendix
  
• D12.2, Benign neoplasm of ascending colon
  
• D12.3, Benign neoplasm of transverse colon
  
• D12.4, Benign neoplasm of descending colon
  
• D12.5, Benign neoplasm of sigmoid colon 
  
• D12.6, Benign neoplasm of colon, unspecified.
  

You will also have K63.5 (Polyp of colon) in ICD-10-CM as a possible code for a polyp of the colon if identified in the documentation in this manner. 

Check Complications for Pseudopolyps

When reporting pseudopolyps of colon in ICD-10-CM, you will need to ensure your physician clearly specifies what complications, if any, occurred with the pseudopolyps.

What are pseudopolyps? Pseudopolyps are also called inflammatory polyps. These often occur in patients with inflammatory bowel disease or ulcerative colitis. 

ICD-9: You have been using 556.4 (Pseudopolyposis of colon) to report these polyps. 

ICD-10-CM Options: In ICD-10-CM, the code 556.4 crosswalks to K51.40 (Inflammatory polyps of colon without complications). The code has also been further extended with K51.4-- where the fifth and sixth digits (11-19) will specify the condition with added complications. You have the following options to choose from:

• K51.411, Inflammatory polyps of colon with rectal bleeding
  
• K51.412, Inflammatory polyps of colon with intestinal obstruction
  
• K51.413, Inflammatory polyps of colon with fistula
  
• K51.414, Inflammatory polyps of colon with abscess
  
• K51.418, Inflammatory polyps of colon with other complication.
  

When your physician documents no complications with pseudopolyps, you report ICD-10-CM code K51.40. When your physician does not specify the complications, you submit code K51.419 (Inflammatory polyps of colon with unspecified complications). “Although before using this code, querying the physician regarding any present complications may be warranted, especially if documentation suggests there may be,” Loya says.

Confirm These Neoplastic Polyp Classifications

Neoplastic polyps have specific classifications, too. They include the adenomatous polyps and adenocarcinomas.

Adenomatous polyps (APs): Oncologists believe this type is the most susceptible for developing into a colorectal cancer, but not all adenomas develop into cancer. Because of the potential for malignancy, most insurers will reimburse follow-up and surveillance procedures for patients who have adenomatous polyps. Patients with APs are usually designated as having a history of colonic polyps. When you spot a past history of colonic polyps, you submit code V12.72 (Personal history of colonic polyps).

When the pathological finding is an “AP of the colon,” and it’s benign, your diagnosis code is 211.3. In ICD-10-CM, you may use D12.- or K63.5. 

Instead of calling it an adenoma, the pathology report may also use one of the following three subcategories of adenomatous polyps to describe it. 

A tubular adenoma is a benign polyp. A villous adenoma of the colon is a carpet-like polyp that can have an uncertain behavior, and a more specific ICD-9-CM code is 235.2 (Neoplasm of uncertain behavior of stomach, intestines, and rectum). In ICD-10-CM, the location of the neoplasm will become important. The codes have been separated under the subcategory D37.- with the fourth digit (1-5) specifying the exact location.

Combination: Occasionally, a polyp is a combination of hyperplastic and adenomatous. Sometimes referred to as a serrated adenoma, you should treat this mixed polyp as if it were adenomatous. It’s also common for patients to have multiple polyps of different morphologies, such as hyperplastic polyps and APs in different locations. If the polyps have different diagnoses, you can report one for each type of polyp.

Adenocarcinomas: When an adenomatous polyp becomes cancerous, it is called an adenocarcinoma and is malignant. Sometimes a neoplastic polyp will contain an area of adenocarcinoma. In these reports, the designation may be “carcinoma in situ.” 

In ICD-9-CM, you have two codes depending on location, 230.4 (Carcinoma in situ of rectum) for carcinoma in situ rectosigmoid and 230.3 (Carcinoma in situ of colon) for carcinoma in situ colon. 

In ICD-10-CM, the corresponding codes for 230.4 are D01.1 (Carcinoma in situ of rectosigmoid junction) and D01.2 (Carcinoma in situ of rectum). ICD-9-CM code 230.3 corresponds to D01.0 (Carcinoma in situ of colon).

Remember: To select the correct ICD-10-CM diagnosis code for a colonic polyp, you will need to know whether the polyp is benign or malignant. Doctors may imply what type of polyp it is in an operative report. However, you will also learn that your physician usually defers to the pathology report before making a final recommendation about when the colonoscopy should be repeated. Your physician will rely on the pathology report for the definitive determination of a colonic polyp’s behavior.

Tip: The final pathology report will determine if a polyp is non-neoplastic or neoplastic. This differentiation is very important in selecting the proper time interval for a follow-up colonoscopy. Although all polyps do not turn cancerous, they may cause gastrointestinal problems such as bleeding and obstruction. Your oncologist may follow up the patient with regular colonoscopies.