Oncology & Hematology Coding Alert

Don’t let these changes become an October surprise.

The 2024 update to ICD-10-CM isn’t large as a whole, but there is a lot in it that will affect oncology coding. From some new benign neoplasm codes to new family history of colonic polyp codes, and a new subcategory of abnormal and inconclusive diagnostic breast images codes, there’s plenty to digest. There’s even a guideline clarification for using Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) that you’ll need to take in and apply to 2024 coding.

Here’s what you need know about the changes before they take effect on Oct. 1, 2023.

Know These New Desmoid Tumor Codes

Perhaps the most significant change to the neoplasm codes is the addition of a new subcategory in the D48 (Neoplasm of uncertain behavior of other and unspecified sites) code category: D48.11- (Desmoid tumor). Chances are you won’t be called upon to use the D48.11- codes much, as the condition, which is benign and affects connective tissue, is pretty rare, affecting well under 2,000 people annually in the United States (source: https://www.desmoidtumors.com/about-desmoid-tumors/).

Still, if you come across the condition, which your oncologist may also refer to as aggressive or desmoid fibromatosis, you should reach for:

• D48.114 (Desmoid tumor, intraabdominal)
• D48.115 (Desmoid tumor of upper extremity and shoulder girdle)
• D48.116 (Desmoid tumor of lower extremity and pelvic girdle)

These codes are pertinent as desmoid tumors frequently appear in patients’ abdomens, arms, and legs. Other codes added include:

• D48.110 (Desmoid tumor of head and neck)
• D48.111 (Desmoid tumor of chest wall)
• D48.112 (Desmoid tumor, intrathoracic)
• D48.113 (Desmoid tumor of abdominal wall)
• D48.117 (Desmoid tumor of back)
• D48.118 (Desmoid tumor of other site)
• D48.119 (Desmoid tumor of unspecified site)

Know These New Benign Digestive System Neoplasm Codes

Another change worthy of mention occurs with D13.9 (Benign neoplasm of ill-defined sites within the digestive system), which now becomes a parent code subdivided into:

• D13.91 (Familial adenomatous polyposis)
• D13.99 (Benign neoplasm of ill-defined sites within the digestive system)

ICD-10-CM 2024 has moved the inclusion terms (benign neoplasm of digestive system NOS, benign neoplasm of intestine NOS, and benign neoplasm of spleen) from the parent code to D13.99, while D13.91 has an instructional note to Code also associated conditions such as D12.6 (Benign neoplasm of colon, unspecified) and C18.- (Malignant neoplasm of colon).

Additionally, you’ll have two other Code also instructions to remember come Oct. 1, 2023. You’ll need to also report D61.818 (Other pancytopenia), if applicable, whenever you code C92 (Myeloid leukemia). And you’ll do the same for D72.18 (Eosinophilia in diseases classified elsewhere), which you will code along with C94.8- (Other specified leukemias), as applicable to the patient’s circumstances.

Know These New Polyp Family History Codes

Oncology coders should also pay attention to the latest additions to Z83.71 (Family history of colonic polyps), which has now been expanded to include four new codes, thus adding more specific colon polyp types:

• Z83.710 (Family history of adenomatous and serrated polyps)
• Z83.711 (Family history of hyperplastic colon polyps)
• Z83.718 (Other family history of colon polyps)
• Z83.719 (Family history of colon polyps, unspecified)

You’ll use Z83.710 for conditions classifiable to D12.- (Benign neoplasm of colon, rectum, anus and anal canal) and for a family history of tubular adenoma polyps, tubulovillous adenoma polyps, and villous adenoma polyps. Additionally, you’ll use Z83.718 to report a family history of inflammatory colon polyps, and Z83.719 for a family history of colon polyps not otherwise specified.

Know These New R92.3- Codes

Starting Oct. 1, 2023, you’ll also have a new subcategory of codes to report abnormal and inconclusive diagnostic breast images. The new subcategory, R92.3 (Mammographic density found on imaging of breast), is subdivided into the following codes depending on the provider’s documented findings:

• R92.31- (Mammographic fatty tissue density of breast)
• R92.32- (Mammographic fibroglandular density of breast)
• R92.33- (Mammographic heterogeneous density of breast)
• R92.34- (Mammographic extreme density of breast)

Each of the above codes will require a 6th character to specify laterality. You’ll use 1 for the right breast, 2 for the left breast, or 3 for a bilateral diagnosis. For example, you’ll assign R92.313 (Mammographic fatty tissue density, bilateral breasts) when the provider issues a finding of fatty tissue density in both breasts.

The new codes correspond to the Breast Imaging Reporting and Data System (BI-RADS). “BI-RADS is commonly referenced in mammogram reports, and it classifies the breast density level into four categories from A to D,” says Taylor Berrena, COC, CPC, CPB, CRC, CPMA, CEMC, CFPC, CHONC, coder II at MD Anderson Cancer Center at Cooper in Yorktown, Virginia.

The BI-RADS breast density categories are as follows:

• Category A: Breasts consist almost entirely of fatty tissue with almost no dense tissue.
• Category B: Breasts consist of a few, scattered areas of fibroglandular density. Most of the breast tissue is still nondense or fatty.
• Category C: Breasts consist of a near equal ratio of dense to nondense tissue. Small masses may be hidden.
• Category D: Breasts consist almost entirely of dense tissue, and the density is so extreme it can lower the sensitivity of the mammogram.

You’ll assign R92.31- codes for Category A or when the provider documents the breast tissue as “nondense” or “fatty tissue.” Category B describes conditions represented by the R92.32- codes. Assign R92.33- codes for findings under Category C or listed as “heterogeneously dense breast tissue.” Lastly, you’ll assign codes from R92.34- for Category D or findings listed as “extremely dense breast tissue.”

This new code group also includes R92.30 (Dense breasts, unspecified). You’ll assign this code if the provider’s documentation doesn’t indicate a specific type of breast tissue density. This code should be used rarely, since you should now be able to match the documented breast tissue density into the four new code subcategories. This may require some awareness training for your providers to capture the information needed to code the results/findings most accurately.

And Know This Follow-up Guideline Advice

Along with adding these new codes and instructions, ICD-10-CM 2024 has also tweaked the guidelines, though this revision only has one small clarification to Guideline I.C.21.c.8 you should be aware of. The change simply tells you that Z08 “may be assigned following any type of completed treatment modality (including both medical and surgical treatments).”