Laterality, Anatomical Specificity Important In ICD-10 Oncology Codes

The transition to ICD-10 has required significant time and resources; however, ICD-10 diagnosis changes—particularly those for oncology—will undoubtedly lead to more accurate clinical research with the hope of improving patient outcomes. ICD-10 capitalizes on anatomical specificity, laterality, and disease process—all of which must be reflected in an oncologist’s documentation and coding. Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, director of ICD-10 development and training at AAPC provides an overview of some of ICD-10 changes relevant for oncology practices to help them prepare for the transition.

1. Breast cancer. ICD-10 code category C50 (malignant neoplasm of the breast) includes anatomical specificity (e.g., nipple and areola, central portion, lower inner quadrant) as well as laterality (i.e., right vs. left) – both of which must be included in medical record documentation. ICD-10 also includes separate codes for male breast cancer, each of which requires anatomical location and laterality.
2. Benign neoplasm of the colon, rectum, anus, and anal canal. Oncologists probably aren’t accustomed to documenting the specific portion of the colon in which the neoplasm exists; however, ICD-10 includes separate codes for benign neoplasms of the cecum (ICD-10 code D12.0), appendix (ICD-10 code D12.1), ascending colon (ICD-10 code D12.2), transverse colon (ICD-10 code D12.3), descending colon (ICD-10 code D12.4), sigmoid colon (ICD-10 code D12.5), and unspecified (ICD-10 code D12.6). Documentation specificity is key to ensuring the correct code assignment. Report ICD-10 code K63.5 when a patient has a polyp of the colon.
3. Sickle cell anemia. Sickle-cell disorders (ICD-10 code category D57) are combination codes that include the type of disease, with or without crisis, and the specific type of crisis (if applicable). Types of Sickle-cell disease include Hb-SS disease, Sickle-cell/Hb-C disease, Sickle-cell trait, Sickle-cell thalassemia, or other Sickle-cell disorders. Types of crises include acute chest syndrome or splenic sequestration. Attention to detail is critical with these codes.
4. Primary liver cancer. ICD-10 code category C22 requires specificity regarding the type of liver cancer, including liver cell carcinoma, intrahepatic bile duct carcinoma, hepatoblastoma, angiosarcoma, or other sarcomas. All of this information is critical for cancer research and treatment.
5. Lymphoma. ICD-10 includes several pages of codes denoting various types of lymphoma. Oncologists should review codes in this section—i.e., code categories C81 through C88. Not only do these codes denote the type of lymphoma, but many of them also require anatomical specificity. For example, ICD-10 code C83.12 denotes Mantle cell lymphoma, intrathoracic lymph nodes.
6. Malignancy in pregnancy. Oncologists must look beyond the neoplasm chapter in the ICD-10 book to subcategory O9A.1- for malignant neoplasms that complicate the pregnancy, childbirth, or puerperium. Specify the specific trimester to ensure correct code assignment. Malignancy in pregnancy is always listed as the principle diagnosis per the ICD-10-CM coding guidelines regardless of the reason for admission.

Know these coding guideline changes

Oncologists should also keep the following guideline change in mind related to anemia and malignancy:

In ICD-10, if a patient is admitted for treatment of anemia due to or associated with a malignancy, report the malignancy as the primary diagnosis. Note that this is just the opposite of ICD-9 that requires coders to report the anemia as the principal diagnosis in this instance.

How to prepare

Oncologists and their staff members should consider these ICD-10 tips:

Review ICD-10-CM codes to identify differences in code descriptions and documentation requirements.

Revise templates and superbills to reflect most common diagnoses.

Create cheat sheets to assist oncologists in selecting the correct code in the EHR.

Always specify anatomical location and laterality.

For more ICD-10 tools and resources, visit the ICD-10 Resource Center.