Pathology/Lab Coding Alert

Turn to op report for tumor site.

As a pathology or lab coder, maybe you’ve sometimes wished for a different or more-specific diagnosis code to report a condition. Starting this fall, the National Center for Health Statistics (NCHS) delivers.

The 2019 ICD-10-CM (clinical modification), which is effective Oct. 1, 2018 through Sept. 30, 2019, implements about 320 new and 170 revised diagnosis codes. We’ve reviewed the full list to identify the changes most relevant to clinical laboratories and pathology practices.

Tip: Even if few ICD-10-CM 2019 revisions and additions impact your specialty, it’s always best to review these changes every year, says Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions Coding Quality and Education Department.

Add Specific Sebaceous-Carcinoma Codes

Effective Oct. 1, you’ll have nearly 50 new codes to describe skin neoplasms of the eyelid.

For starters, the code set includes a new code family to describe sebaceous carcinoma of the eyelid: C44.13 (Sebaceous cell carcinoma of skin of eyelid, including canthus). The new family includes the following codes:

• 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)

Prior to adding this code family, you would have reported sebaceous cell carcinoma of the eyelid using one of the codes under C44.19- (Other specified malignant neoplasm of skin of eyelid, including canthus).

Remember: To find these new codes when coding from a pathology report, you can look up the histological term for the neoplasm, such as “sebaceous carcinoma,” in the Alphabetic Index and note the code and any other instructions. Then when you check the Neoplasm Table, you’ll know which column is appropriate for the patient’s diagnosis. That’s why you should always check the Alphabetical Index first, according to Lisa Selman-Holman, JD, BSN, RN, COS-C, HCS-D, HCS-O, with Selman-Holman & Associates, LLC, and CoDR in Denton, Texas.

See “Don’t Miss ‘Upper,’ ‘Lower’ Eyelid Distinction” on page 67 for a peek at other new eyelid neoplasm codes.

Update Inherited/Metabolic Disorder Code Choices

If your lab performs tests to assess inherited or metabolic disorders, you have a host of new ICD-10-CM codes that you may encounter to code the conditions.

Beginning Oct. 1, you might need to use one of the following new codes for certain disorders:

• E72.81 (Disorders of gamma aminobutyric acid metabolism)
• E72.89 (Other specified disorders of amino-acid metabolism)
• E75.26 (Sulfatase deficiency)
• E88.02 (Plasminogen deficiency)
• Q93.51 (Angelman syndrome)
• Q93.59 (Other deletions of part of a chromosome)
• Q93.82 (Williams syndrome).

There’s more: To document various conditions associated with lipid metabolism, you’ll need to be familiar with the following new codes, effective Oct. 1:

• E78.41 (Elevated Lipoprotein(a))
• E78.49 (Other hyperlipidemia)
• Z83.43- (Family history of other disorder of lipoprotein metabolism and other lipidemias)
• Z83.430 (… elevated lipoprotein(a))
• Z83.438 (… other disorder of lipoprotein metabolism and other lipidemia).

Capture Newborn Conditions

ICD-10-CM 2019 adds more specific codes for disturbances of sodium, potassium, and electrolyte balance in newborns. Beginning Oct. 1, you may see clinicians ordering blood tests with one of these more-specific diagnosis codes:

• P74.21 (Hypernatremia of newborn)
• P74.22 (Hyponatremia of newborn)
• P74.31 (Hyperkalemia of newborn)
• P74.32 (Hypokalemia of newborn)
• P74.41 (Alkalosis of newborn)
• P74.42 (Disturbances of chlorine balance of newborn)
• P74.421 (Hyperchloremia of newborn)
• P74.422 (Hypochloremia of newborn)
• P74.49 (Other transitory electrolyte disturbance of newborn).

Another new code allows practitioners to identify babies who are born with a Zika virus syndrome: P35.4 (Congenital Zika virus disease).

Specify Urinalysis Findings

Similar to the changes in newborn blood chemistry, ICD-10-CM 2019 adds specificity for low and high levels of a substance in urine with the addition of the following codes:

• R82.991 (Hypocitraturia)
• R82.992 (Hyperoxaluria)
• R82.993 (Hyperuricoscuria)
• R82.994 (Hypercalciuria)
• R82.998 (Other abnormal findings in urine).

You’ll have one code revision in ICD-10-CM 2019 that relates to new-code R82.992. Effective Oct. 1, diagnosis E72.53 will be updated to reference “Primary hyperoxaluria” rather than the current diagnosis which is simply “Hyperoxaluria.”

“The ‘primary hyperoxaluria’ indicates an inherited or congenital disease process leading to the increased oxalate urinary excretion,” explains Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York in Stony Brook. “The new ICD-10-CM code R82.992 represents hyperoxaluria of unknown etiology, idiopathic in nature.”