Oncology & Hematology Coding Alert

Plus see how your ICD-9 and ICD-10 options compare.

Choosing the appropriate ICD-9 code for Hodgkin's lymphoma is a key element of your claim for treatment under the Stanford V regimen. Unfortunately, if you don't know where to look, you could easily neglect to add the fifth digit this code range requires. Below, find tips on which ICD-9 codes will most likely apply to your Stanford V claims.

Note: For a discussion of the proper HCPCS codes for the drugs typically used for this chemotherapy regimen, which was created to treat Hodgkin's lymphoma, see Oncology and Hematology Coding Alert, vol. 12, no. 9, "Part 1: Watch HCPCS to Clinch Clean Stanford V Claims."

Take a Closer Look at Hodgkin's Lymphoma

Hodgkin's lymphoma, also called Hodgkin's disease, is a disease of the lymphatic system, which is part of the body's immune system. The lymphatic system includes lymph nodes, which are found throughout the body, and small vessels called lymphatics that connect the nodes. The lymphatic system also includes the spleen, thymus gland, tonsils, and bone marrow. The disease involves abnormal cells that don't die the way normal cells do and produce more abnormal cells.

As the disease progresses, it can diminish the body's ability to fight infection. Choosing the appropriate ICD-9 code for Hodgkin's lymphoma can be a challenge. The first step is to narrow down your options to a single code range: 201.xx, Hodgkin's disease. Check Pathology Report for Subcategory Once you've determined that your appropriate code is in the 201.xx range, you'll need to choose which fourth digit applies to your case.

Smart move: "You must look at the pathology report to ensure that you are coding to the highest degree of specificity," says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill.

Be sure to consider whether a physician has confirmed the diagnosis contained on the pathology report and whether the diagnosis is relevant to the claim type you are coding. If the pathology report is present, but not linked to the provider's documentation, query the provider for the most specific ICD-9 code to use on the date of service.

Get specific: ICD-9 does offer a code for unspecified Hodgkin's lymphoma, 201.9x (Hodgkin's disease, unspecified), says Martin. But "there are seven other specific subcategories of Hodgkin's disease in addition to 201.9[x]," she explains.

The codes are as follows:

• 201.0x -- Hodgkin's paragranuloma
• 201.1x -- Hodgkin's granuloma
• 201.2x -- Hodgkin's sarcoma
• 201.4x -- Lymphocytic-histiocytic predominance
• 201.5x -- Nodular sclerosis (includes cellular phase and not otherwise specified types of nodular sclerosis)
• 201.6x -- Mixed cellularity
• 201.7x -- Lymphocytic depletion (includes diffuse fibrosis, reticular type, and not otherwise specified types of lymphocytic depletion)
• 201.9x -- Hodgkin's disease, unspecified (includes malignant lymphogranuloma, malignant lymphogranulomatosis, and not otherwise specified types of Hodgkin's lymphoma).

Don't Forget Required 5th Digit

If you use a manual, missing the fifth digit required for Hodgkin's diagnosis coding is an easy mistake to make. That's because many manuals post the fifth digit options before the 200.xx range (Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissues).

Reason: The fifth-digit options apply for 200.xx, 201.xx, and 202.xx (Other malignant neoplasms of lymphoid and histiocytic tissue), so the manual places the shared digits at the beginning of the relevant code ranges. But you must choose one of the following fifth-digit options for your 201.xx code for payers to accept it:

• 0 -- ... unspecified site, extranodal and solid organ sites
• 1 -- ... lymph nodes of head, face, and neck
• 2 -- ... intrathoracic lymph nodes
• 3 -- ... intra-abdominal lymph nodes
• 4 -- ... lymph nodes of axilla and upper limb
• 5 -- ... lymph nodes of inguinal region and lower limb
• 6 -- ... intrapelvic lymph nodes
• 7 -- ... spleen
• 8 - ... lymph nodes of multiple sites.

Tip: "The fifth digit sub-classification is based on the lymph nodes involved, so again, it is almost essential to have the pathology report for accurate coding," Martin says.

Expect 4th and 5th Digit Changes for ICD-10

CMS has indicated that the requirement to change from the ICD-9 system to ICD-10 will be effective Oct. 1, 2013. When that occurs, you'll have to get used to choosing from codes with definitions that may differ from what you're used to.

"Start researching and preparing a minimum of six months before implementation of ICD-10 -- there's a lot for most of us to learn because, yes, there are lots of differences, but the payoff will be much greater specificity," Martin says. One step you can take now is to look at the ICD-10 2010 codes that apply to the diagnoses you report most often. Note whether they require different information than their ICD-9 counterparts, and share that information with providers so they can get used to including that information in their documentation before the transition.

Example: Here is a list of the ICD-10 2010 codes for Hodgkin's lymphoma. (The "-" indicates you need to add another digit for a complete code.)

• C81.0 -- Nodular lymphocyte predominant Hodgkin lymphoma
• C81.1 -- Nodular sclerosis classical Hodgkin lymphoma
• C81.2 -- Mixed cellularity classical Hodgkin lymphoma
• C81.3 -- Lymphocytic depletion classical Hodgkin lymphoma
• C81.4 -- Lymphocyte-rich classical Hodgkin lymphoma

Excludes1: nodular lymphocyte predominant Hodgkin lymphoma (C81.0-)

• C81.7 -- Other classical Hodgkin lymphoma Classical Hodgkin lymphoma NOS
• C81.9 --  Hodgkin lymphoma, unspecified.

Although ICD-10 as currently published lists all codes individually with the full description (unlike the current ICD-9 tabular format), you can see that like ICD-9, the ICD-10 2010 Hodgkin's codes require a fifth character for each of the above subclassifications. The ICD-10 options are similar to ICD-9, except that you will have separate ICD-10 options for unspecified site (0) and extranodal and solid organ sites (9). In ICD-9, the two are lumped together under 0.

Your ICD-10 options for the fifth character include:

• 0 -- ... unspecified site
• 1 -- ... lymph nodes of head, face, and neck
• 2 -- ... intrathoracic lymph nodes
• 3 -- ... intra-abdominal lymph nodes
• 4 -- ... lymph nodes of axilla and upper limb
• 5 -- ... lymph nodes of inguinal region and lower limb
• 6 -- ... intrapelvic lymph nodes
• 7 -- ... spleen
• 8 -- ... lymph nodes of multiple sites
• 9 -- ... extranodal and solid organ sites.

Compare ICD-9 to ICD-10: "The CMS website has educational materials available that you can review, so there is a lot of good quality yet free information available," Martin says. One tool available through the CMS site (www.cms.gov/ICD10) is the file showing General Equivalence Mappings (GEMs) between ICD-9 and ICD-10.

This table summarizes the ICD-10 to ICD-9 GEMs shown for Hodgkin's lymphoma:

The AAPC also has a free ICD-10-CM Code Translator tool based on GEMs available at www.aapc.com/ICD-10/codes/index.aspx. You can also find an ICD-10 Bridge at https://www.aapc.com/codes/.