Oncology & Hematology Coding Alert

Check grade and acquaint yourself with terminologies to make way to the right code.

When reporting myelodysplastic syndrome (MDS), it’s critical to determine what grade of the disease the physician documented -- and making that call can be difficult if you do not have clarity for types of MDS. In ICD-10-CM, your coding will be guided by the type of MDS documented. 

Be Specific For Low Grade MDS

ICD-9-CM option: In ICD-9-CM, you report code 238.72 (Low grade myelodysplastic syndrome lesions) for MDS. This code applies to: 

• Refractory anemia (RA), 
• Refractory anemia with excess blasts-1 (RAEB-1), 
• Refractory anemia with ringed sideroblasts (RARS)
• Refractory cytopenia with multilineage dysplasia (RCMD), and 
• Refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS).

ICD-10-CM options: Unlike ICD-9-CM, ICD-10-CM offers more specific codes depending upon the type of MDS. You will select from the following according to the type your physician documents:

• D46.0, Refractory anemia without ring sideroblasts, so stated
• D46.1, Refractory anemia with ring sideroblasts
• D46.20, Refractory anemia with excess of blasts, unspecified
• D46.21, Refractory anemia with excess of blasts 1
• D46.A, Refractory cytopenia with multilineage dysplasia
• D46.B, Refractory cytopenia with multilineage dysplasia and ring sideroblasts
• D46.4, Refractory anemia, unspecified

Watch For One-To-One Match for High Grade MDS

You find will a one-to-one match in for high grade MDS. In ICD-9-CM, you report code 238.73 (High grade myelodysplastic syndrome lesions). This code maps to code D46.22 (Refractory anemia with excess of blasts 2) in ICD-10-CM. 

What is new in ICD-10-CM? The descriptor of code D46.22 is more specific when compared to that of ICD-9-CM code 238.73. The descriptor clearly mentions that there is an excess of blasts. There are more blasts (10-20%) in the bone marrow when compared to refractory anemia with excess of blasts 1 (less than 10%). Hence it is called high grade MDS. According to the American Cancer Society, this type of MDS is about 50% likely to turn into acute myeloid leukemia.