Pathology/Lab Coding Alert

ICD-10-CM 2019:

Don't Miss 'Upper,' 'Lower' Eyelid Distinction

Published on Mon Aug 06, 2018

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More than 40 new codes specify eyelid cancer.

You read about the following new eyelid sebaceous-cell carcinoma codes in “Mark Changes to Coding Neoplasms, Metabolic Disorders, and More” on page 66:

C44.131 (Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus)
C44.132- (… right eyelid, including canthus)
C44.1321 (… right upper eyelid, including canthus)
C44.1322 (… right lower eyelid, including canthus)
C44.139- (… left eyelid, including canthus)
C44.1391 (… left upper eyelid, including canthus)
C44.1392 (… left lower eyelid, including canthus)

But those are just a few of the many new codes for eyelid cancer in ICD-10-CM 2019, effective Oct. 1. Read on to learn about other new options for coding eyelid cancer beginning this fall.

Similar: You’ll notice that the new code family follows the pattern of the existing codes for eyelid tumors, starting with unspecified eyelid (C44.131), then right eyelid (C44.132-), then left eyelid (C44.139-).

Different: You’ll also notice that the new code family includes an extra, final position for right and left eyes— “1” for upper eyelid, and “2” for lower eyelid. The Oct. 1 ICD-10-CM update also makes this change for all other eyelid neoplasm codes, adding 38 new codes with a “1” or “2” in the final position to indicate upper or lower eyelid.

For example: ICD-10-CM adds two codes under C43.11-

C43.111 (Malignant melanoma of right upper eyelid, including canthus)
C43.112 (… right lower eyelid, including canthus)

and two codes under C43.12-:

C43.121 (Malignant melanoma of left upper eyelid, including canthus)
C43.122 (… left lower eyelid, including canthus)

“To use these more-specific codes, the pathologist will need to find specific information from the operative report concerning whether the tissue is from the upper or lower eyelid,” says R.M. Stainton Jr., MD, president of Doctors’ Anatomic Pathology Services in Jonesboro, Ark.

Similarly, the Oct. 1 update adds the final position “1” and “2” to the following codes to distinguish upper or lower eyelid:

C4A.11- (Merkel cell carcinoma of right eyelid, including canthus)
C4A.12- (… left eyelid, including canthus)
C44.102- (Unspecified malignant neoplasm of skin of right eyelid, including canthus)
C44.109- (… skin of left eyelid, including canthus)
C44.112- (Basal cell carcinoma of skin of right eyelid, including canthus)
C44.119- (… left eyelid, including canthus)
C44.122- (Squamous cell carcinoma of skin of right eyelid, including canthus)
C44.129- (… skin of left eyelid, including canthus)
C44.192 (Other specified malignant neoplasm of skin of right eyelid, including canthus)
C44.199 (…skin of left eyelid, including canthus)
D03.11 (Melanoma in situ of right eyelid, including canthus)
D03.12 (…left eyelid, including canthus)
D04.11 (Carcinoma in situ of skin of right eyelid, including canthus)
D04.12 (… left eyelid, including canthus)
D22.11 (Melanocytic nevi of right eyelid, including canthus)
D22.12 (…left eyelid, including canthus)
D23.11 (Other benign neoplasm of skin of right eyelid, including canthus)
D23.12 (… skin of left eyelid, including canthus).

Do this: In addition to noting right or left eye in the documentation, make sure you look for “upper” or “lower” eyelid information before choosing the proper eyelid-tumor code in ICD-10-CM 2019.