Pathology/Lab Coding Alert

The annual update of ICD-9 includes the addition of about 60 codes, including one new category and four new subcategories, as well as the revision of nearly 40 other codes. Medicare is accepting the new codes beginning Oct. 1, 2001, although providers are not required to use the latest version of ICD-9 until Jan. 1, 2002. Third-party payers are not likely to accept the new codes before the beginning of next year. A complete list of the code changes is available on the Internet at www.hcfa.gov/pubforms/transmit/AB0191.pdf. Of particular interest to pathology Coder are new codes for dysplasia of prostate, dysmetabolic syndrome X and several V codes, including a new category for genetic carrier status.
 
A new code was added for a frequent pathological finding from prostate needle biopsy:
 

602.3 dysplasia of prostate, prostatic intraepithelial neoplasm I (PIN I), prostatic intraepithelial neoplasm II (PIN II); excludes prostatic intraep ithelial neoplasm III (PIN III) (233.4).
 
The code describes a finding of dysplastic cells (abnormal in shape or size) that is commonly premalig-nant and therefore is monitored closely with repeat biopsy. The condition is differentiated from benign hyperplasia, 600.x, which is a proliferation of normal cells. Prior to the addition of this code, dysplasia of prostate was reported with 602.8 (other specified disorders of prostate).
 
Dysplasia of prostate has three levels of prostatic intraepithelial neoplasm classification. The new code is used for PIN I and PIN II, while PIN III is reported with 233.4 (carcinoma in situ of prostate). The new code allows reporting of PIN similar to the reporting of vulvar intraepithelial neoplasia (VIN) and cervical intraepithelial neoplasia (CIN). Code 602.3 is listed under dysplasia: prostate in ICD-9 Volume 2 (alphabetic index).
 
A new code was added for a newly recognized syndrome characterized as an increased cellular resistance to insulin:
 

277.7 dysmetabolic syndrome X, use additional code for associated manifestation, such as: cardiovascular disease (414.00-414.05), obesity (278.00-278.01).
 
The instructions following the code indicate that it is to be reported in addition to codes for the symptomatic manifestations of the illness, such as obesity, coronary artery disease hypertension and abnormal blood lipid profile. The category for this code is 277 (other and unspecified disorders of metabolism). Prior to ICD-9 2002, dysmetabolic syndrome X was reported with 277.8 (other specified disorders of metabolism).
 
A new category has been added to ICD-9 2002 to report genetic carrier status. The new codes in this category involve carrier status for hemophilia A, although carrier status for other inherited illnesses may be added in the future.
 
The new category is V83 (genetic carrier status). The new subcategory is V83.0 (hemophilia A carrier). The new codes are V83.01 (asymptomatic hemophilia A carrier) and V83.02 (symptomatic hemophilia A carrier).
 
Remember not to report either V83 or V83.0, because the fifth digit is required, meaning the patient must be classified as either a symptomatic or asymptomatic carrier. The new V83 category is only for codes describing carrier status for a disease that can be passed on genetically, not for every gene-related disease a patient could develop. This will limit the number of new codes in this category.