ICD-10 and Skin Cancer
Specificity with skin cancers is taken to another level when we step into ICD-10-CM. Documentation will require the type of skin cancer such as Basal Cell Carcinoma, Squamous Cell Carcinoma, Carcinoma in-situ, Melanoma, and Melanoma in-situ. The documentation must also include laterality. Some examples are:
Patient presents with melanoma in-situ of her left forearm.
ICD-9-CM would report 172.6:
Melanoma of upper limb, including shoulder
ICD-10-CM would report
Melanoma in-situ of left upper limb, including shoulder
The documentation of right or left for location of the skin cancer is not limited to just the diagnosis of melanoma in-situ but also with melanoma of the skin.
Patient is a 49-year-old male, with a melanoma of his nose near the ala of the right side. This was diagnosed by Dr. Derm on 10/20/20xx. He has never had a skin cancer.
PHYSICAL EXAMINATION: On examination, the patient has a healed wound of his nose. It is about 8 mm in greatest diameter. He has no lymphadenopathy of his parotid or of neck. I have examined those areas. He has acne scars on his face.
MEDICAL DECISION MAKING: The patient has a melanoma of the nose near the ala on the right side. With the patient's permission, I have drawn how I would excise this and my best guess at the resultant scar. Like with any surgery there is a risk of infection and bleeding that is low. There is a risk of the skin cancer coming back. We are going to make that as low as possible by having a pathologist present to look at the edges thoroughly to make sure we get it all out. Alternatives to surgery would be removal by a dermatologist or radiation therapy. We are going to get this done within the next few weeks.
ICD-9-CM would report 172.3:
Malignant melanoma of skin of other and unspecified parts of face
ICD-10-CM would report C43.31:
Malignant melanoma of the nose
Other areas that require more specificity include the eyelid, ears, skin of the anus, and the breast. Be sure to check your documentation now to be prepared for these changes.
IN THE NEWS
Listening Sessions on End-to-End Testing
National Government Services (NGS), under contract to the Centers for Medicare & Medicaid Services (CMS), has announced additional listening sessions on end-to-end testing for April. These listening sessions are essential in gathering insights and feedback from the healthcare industry on end-to-end testing of ICD-10 and other HIPAA administrative simplification requirements.
NGS has posted draft checklists to the End-to-End Testing section of the CMS website for discussion during upcoming listening sessions. The checklists focus on testing for:
- Large practices
- Small practices
- Vendor to provider
- Vendor to payer
Industry feedback through these listening sessions will allow further refining of these checklists. Email NGS to register for one of the following listening sessions.
Listening Session Schedule:
|April 16, 2013
||2-3 pm (ET)
|April 18, 2013
||2-3 pm (ET)
||Vendor to Provider
|April 23, 2013
||2-3 pm (ET)
||Vendor to Payer
|April 25, 2013
||2-3 pm (ET)
|April 30, 2013
||2-3 pm (ET)
PROCEDURE: Colon incomplete, Colonoscopy with polypectomy by hot biopsy technique
INDICATIONS: Screening, probable diverticulosis
MEDICATIONS: MAC per Anesthesia
DESCRIPTION OF PROCEDURE: After the risks, benefits, and alternatives of the procedure were thoroughly explained, informed consent was obtained. Digital rectal exam was performed and revealed no abnormalities. The endoscope was introduced through the anus and advanced to the mid transverse colon. The quality of the prep was inadequate, and I was unable to advance beyond mid-transverse colon due to significant amount of retained stools. The instrument was then slowly withdrawn.
IMPRESSION: 1) Unable to pass beyond transverse colon 2) Diffuse diverticulosis in descending and sigmoid colon 3) 4 polyps in rectum removed with hot biopsy.
PATHOLOGY: Pending results
Z13.811 Encounter for screening for lower gastrointestinal disorder
K62.1 Rectal polyp
K57.30 Diverticulosis of large intestine without perforation or abscess without bleeding
Rationale: In ICD-10-CM, documentation of codes for screenings must include any abnormal findings, which–if found–would be listed secondarily to the screening code. Screening codes in ICD-10-CM can be broken down by the condition, procedure, or anatomic location depending on the type of screening. In our example above, the patient presents for a screening colonoscopy to determine if this patient has diverticulosis. Because the main reason for the procedure is a screening, the appropriate primary code would be Z13.811. We next need to report the abnormal findings from the procedure—in this case the patient's polyp and diverticulosis.
ICD-10 IMPLEMENTATION STRATEGIES
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
AAPC has performed thousands of ICD-10 documentation assessments and we've noticed that only 40 percent of today's documentation is ready for the transition. This confirms that one of the largest problems following the October 1, 2014 implementation date will be insufficient documentation to support the specificity required to assign the new ICD-10 code sets. These assessments have mostly been forgotten among the other education, training, and implementation objectives. Even if an office is fully prepared for ICD-10 but clinical documentation has not improved, accurate coding and proper payment will not be possible. We believe a behavioral change in documentation habits for most providers will be necessary—and now is the time to start preparing.
While most providers are feeling the increasing demands of the transition to ICD-10 it may be surprising that the documentation they currently have may only need small tweaks to include the detail required to allow for the specificity of the ICD-10-CM code set. ICD-10 will not change how physicians care for their patients but it may change how documentation reflects the reasons for that care. If the new documentation requirements are examined, virtually all are important in defining the nature of the patient's condition.
Documentation assessments performed now will find those weak spots and allow sufficient time to educate the provider on the changes that need to be made. Documentation assessments will also help these items on your ICD-10 implementation checklist:
- Finds weak points in current coding practices
- Indicates the frequently used codes in your practice
- Allows for an accurate update to your billing sheets (eliminates the prospect of pages of possible used codes)
Documentation assessments are not meant to be performed on every case seen in your practice. Focus instead on the top 50 common diagnoses seen in your office. When assigning ICD-10 codes to the documentation you should focus on not reporting an unspecified code unless it is absolutely unavoidable. Make note of any deficiencies that you find and develop your physician training based on these deficiencies. Completing this important facet of the implementation process will provide you with clear direction for future trainings until the implementation date. At that time, you should do another assessment to see if additional training is required.
ICD-10 Implementation Tracker
AAPC's implementation tracker tool is the best way for you to stay on top of the ICD-10 transition. This online application is used to track and graphically measure the ICD-10 implementation progress of an individual or organization. The tool lists tasks within key steps of the implementation process and then charts their completion against a recommended timeline/schedule to ensure minimal disruption to your organization.