Pathology/Lab Coding Alert

Tip: Dx drives follow-up frequency rules With the implementation of pay-for-performance, reimbursement for repeat colonoscopy depends on frequency rules linked to the diagnosis. That's why now, more than ever before, you need to accurately translate the pathology report language into ICD-9 codes.

From polyps to colon cancer, follow our experts- advice for assigning colon-specimen diagnoses.

Don't be fooled: Although your first stop is often the neoplasm table, you need to be familiar with these non-neoplastic polyps that you won't find in the table:

- Inflammatory or pseudopolyps: These often occur in patients with inflammatory bowel disease or ulcerative colitis. Use 556.4 (Pseudopolyposis of colon) to report these polyps instead of a code from the neoplasm table.

- Hamartomatous polyps: Also called Peutz-Jeghers polyps or juvenile polyps, you should report these with 759.6 (Other and unspecified congenital anomalies; other hamartoses, not elsewhere classified), rather than a code from the neoplasm table. Check Out the Neoplasm Table If the colon specimen is not pseudopolyps or hamartomatoses, you-ll need to start with the neoplasm table to find the condition. ICD-9 distinguishes neoplasms as benign, malignant, of uncertain behavior, or carcinoma in situ. Look up -neoplasm- in the ICD-9 Index to Diseases (Volume 2), and then find -intestine, large- in the neoplasm table.

Good advice: Once you-ve found the diagnosis code in the neoplasm table, verify it in ICD-9's tabular list (Volume 1). The code descriptions in the tabular list help identify which colon sites the code covers.

For example: You are trying to find the code for a benign polyp in the rectosigmoid junction. The neoplasm table lists 211.3 for benign colonic polyp and 211.4 for benign rectal polyp. You have to turn to the tabular list to find out which code is correct. A note under 211.3 states, -excludes rectosigmoid junction (211.4),- so you know that 211.4 is the correct code for your specimen.

Learn Common Terminology Because the pathology report may use many terms that you won't find in ICD-9, follow our experts- advice about how to classify these terms. For tissue from the colon or rectum, you should be familiar with the following classifications:

- Mucosal polyps: These are usually benign, and you should report them as 211.3 (Benign neoplasm of colon), according to Pamela Younes, MHS, HTL (ASCP), CPC, PA (ASCP), assistant professor at Baylor College of Medicine in Houston.

- Hyperplastic polyps: Hyperplastic polyps are also benign, so you should also report them as 211.3. Hyperplasia can also occur in the rectal region, which you should submit as 211.4 (Benign neoplasm of rectum and anal canal), Younes says.

- Adenomatous polyps (APs): Most colorectal cancers arise from this polyp type, but not all APs develop into cancer. Because of the potential for malignancy, most [...]