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CODING ALERT

Neoplasm codes changed in ICD-10

 

By Judy Monestime  bio

Watch for changes in neoplasm codes in ICD-10 CM. Chapter 2 of ICD-10 CM, ranging from C00 to D49, includes neoplasm codes which provide greater detail than ICD-9-CM codes for reporting neoplasms.

The chapter includes these blocks

C00-C14   Malignant neoplasms of lip, oral cavity and pharynx

C15-C26   Malignant neoplasms of digestive organs

C30-C39   Malignant neoplasms of respiratory and intrathoracic organs

C40-C41   Malignant neoplasms of bone and articular cartilage

C43-C44   Melanoma and other malignant neoplasms of skin

C45-C40   Malignant neoplasms of mesothelial and soft tissue

C50   Malignant neoplasms of breast

C51-C58 – Malignant neoplasms of female genital organs

C60-C63   Malignant neoplasms of male genital organs

C64-C68   Malignant neoplasms of urinary tract

C69-C72   Malignant neoplasms of eye, brain and other parts of central nervous system

C73-75  Malignant neoplasms of thyroid and other endocrine glands

C7A   Malignant neuroendocrine tumors

C7B   Secondary neuroendocrine tumors

C76-C80   Malignant neoplasms of ill-defined, other secondary and unspecified sites

C81-C96   Malignant neoplasms lymphoid, hematopoietic and related tissue

D00-D09   In situ neoplasms

D10-D36   Benign neoplasms, except benign neuroendocrine tumors

D3A   Benign neoendocrine tumors

D37-D48   Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes

D49   Neoplasms of unspecified behavior

Terminology and sequencing changes

In Chapter 2 of ICD-10 CM, there have been changes from ICD-9 including terminology and sequencing. For example, terminology for neoplasm codes that identify admission status; in ICD-9 the terminology used is “without mention of remission.” However, in ICD-10 the terminology is now “not having achieved remission.”

Another change in the neoplasm chapter is guidelines related to the sequencing of neoplasm codes. The ICD-9-CM Official Guidelines for Coding and Reporting state: “When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate anemia code (such as code 285.22, Anemia in neoplastic disease) is designated as the principal diagnosis and is followed by the appropriate code(s) for the malignancy.”

Pay attention to guideline

Pay careful attention to coding guideline I.C. 2.c.1, anemia associated with malignancy. The ICD-10-CM Official Guidelines for Coding and Reporting state:When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).”

When the admission is for management of anemia associated with malignancy and the treatment is only for the anemia, in ICD-9-CM, coders sequence the anemia first. Under ICD-10, the malignancy code is sequenced first followed by the anemia code.

Let’s practice! How do you code the following?

Female patient comes in today due to severe anemia due to right breast carcinoma of the central portion.

C50.111  Malignant neoplasm of central portion of right female breast

D63.0   Anemia in neoplastic disease

Rationale: The ICD-10-CM Official Guidelines for Coding and Reporting instruct coders to sequence the malignancy code as the principal diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease). So in this example code C50.111 (Malignant neoplasm of central portion of right female breast) would be the principal diagnosis followed by code D63.0 (Anemia in neoplastic disease).

Judy Monestime, MBA, CDIP, CPC, is an AHIMA-approved ICD-10-CM/PCS trainer.

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