Gastroenterology Coding Alert

New code for ICD-10 will specify contiguous or overlapping sites.

When using the ICD-9-CM code set, you would usually report 153.8 (Malignant neoplasm of other specified sites of large intestine) for patients diagnosed with colon (colorectal) cancer. Colon or colorectal cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Other types of cancer can affect the colon, such as lymphoma, carcinoid tumors, melanoma, and sarcomas.

ICD difference: Effective Oct. 1, 2013, 153.8 maps directly to C18.8 (Malignant neoplasm of overlapping sites of colon). The ICD-10 code's descriptor slightly changes to indicate contiguous or overlapping sites.

Documentation:

Remember, if the provider performs a colon cancer test because the patient shows signs and symptoms, you would use the sign and symptom code to explain the reason for the test, not the screening code. For instance in colonoscopy, V76.51 (Special screening for malignant neoplasms; colon) should appear as the primary diagnosis if the reason for the visit is specifically for an average-risk screening exam.

Coder tips:

If the cancer has already reached neighboring tissue of the colon, the physician could have a hard time deciding on the cancer's primary site. In this case, you would code 153.8. ICD-9-CM classifies situations of contiguous sites through the use of a fourth digit, 8, to indicate overlapping sites within the same organ.