Dermatology Coding Alert

Expanded diagnosis code sets will allow coders to classify whether skin cancer is basal, squamous, or unspecified.

On October 1, dermatology coders will be able to more accurately report the location of carcinomas and other neoplasms of the skin.

The Centers for Medicare & Medicaid Service (CMS) has released its proposed changes to ICD-9 2012, and they include an expansion of the 173.x (Other malignant neoplasm of skin) series. Each code in that series will get a list of fifth digits that will specify whether the malignant neoplasm is basal cell, squamous cell, or unspecified.

Example: Now, dermatology coders would report 173.0 (Other malignant neoplasm of skin of lip) for any non-melanoma malignant neoplasm of the lip. But when ICD-9 2012 becomes effective on October 1, 2011, coders can choose from:

• 173.00 -- Unspecified malignant neoplasm of skin of lip
• 173.01 -- Basal cell carcinoma of skin of lip
• 173.02 -- Squamous cell carcinoma of skin of lip
• 173.09 -- Other specified malignant neoplasm of skin of lip.

Additionally, in October, 173.0 will become an invalid diagnosis code.

The changes in the other skin cancer categories follow this pattern, with the fifth digit of "0" referring to an unspecified malignant neoplasm, "1" denoting a basal cell cancer, "2" referring to a squamous cell carcinoma," and "9" describing another specified malignant neoplasm.

The new, revised, and invalid codes have been approved by the by the ICD-9-CM Coordination and Maintenance Committee and were published in the Federal Register on May 5, 2011. After the new codes take effect on Oct. 1, CMS will only add new ICD-9 codes on an emergency basis as it prepares to switch over the diagnosis coding system to ICD-10.

Get Staff Up to Speed on Changes

With only a few months before implementation, the time to act is now, says Pamela Biffle, CPC, CPC-P, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas.

"Coders will have to maker sure their systems are updated with the new codes," she notes. "Training will have to be done for all the staff."

Good idea: "This is a great example of when to have a lunch and learn session for all providers and other clinical staff that may be assigning diagnosis codes," Biffle suggests.

New Codes Will Ease Cancer Classifications

The Coordination and Maintenance Committee expanded the code series thanks to a request from the New York State Cancer Registry.

"The vast majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries," said the organization in its proposal. "Because of the difficulty in distinguishing reportable skin cancers from non-reportable skin cancers the facilities are transmitting all skin cancers to central registries. This places an additional burden on central registries and also results in the transmission of confidential patient information on patients whose information should not be reported." The expansion of the codes under category 173 will allow for the differentiation of reportable and non-reportable (basal and squamous cell) skin cancers."

Watch for: It's uncertain whether there will be expanded skin neoplasm codes when coders update their diagnosis codes in 2013 with ICD-10. Currently, ICD-10 is slated to include C44.0-C44.9 (Other malignant neoplasms of skin ...), a code series that does not have the specificity as the proposed ICD-9 2012 codes. Keep reading Dermatology Coding Alert for more information on skin cancer ICD-10 codes as they become available.