ICD 10 Coding Alert

Melanoma and more report to different codes.

Not a lot will change once you start reporting malignant skin neoplasms with ICD-10, but we have the low-down on a few key differences to keep your diagnosis coding on track for skin biopsy and excision cases.

Recall: CMS has finalized the ICD-10 implementation date for Oct. 1, 2014, delaying the action one year from the original deadline.

Stay the Course for Excludes/Includes

Both C44.9 in ICD-10 and 173.0 in ICD-9 (Other and unspecified malignant neoplasm of skin) include malignant neoplasm of sebaceous glands. The two code families also share the same condition exclusions, as follows:

Kaposi’s sarcoma of skin (C46.0) (176.0-176.9)

melanoma of skin (C43.-) (172.0-172.9)

neoplasm of skin of genital organs (C51.—C52, C60.-, C63.2, C63.9) (184.0-184.9, 187.1-187.9)

Merkel cell carcinoma of skin (C4A.-) (209.31-209.36).

Expect Greater ICD-10 Site Detail

You’ll find a direct crosswalk between other and unspecified neoplasm of skin codes for ICD-9 and ICD-10 at the fourth-character level, as follows:

173.0 — ... lip crosswalks to C44.0 (same definition)

173.1 — ... eyelid, including canthus crosswalks to C44.1 (same definition)

173.2 — ... ear and external auditory canal crosswalks to C44.2 (ear and external auricular canal)

173.3 — ... other and unspecified parts of face crosswalks to C44.3 (same definition)

173.4 — ... Scalp and skin of neck crosswalks to C44.4 (scalp and neck)

173.5 — ... Skin of trunk, except scrotum crosswalks to C44.5 (trunk)

173.6 — ... Skin of upper limb, including shoulder crosswalks to C44.6 (same definition)

173.7 — ... Skin of lower limb, including hip crosswalks to C44.7 (same definition)

173.8 — ... Other specified sites of skin (text note: malignant neoplasm of contiguous or overlapping sites of skin whose point of origin cannot be determined) crosswalks to C44.8 (overlapping sites of skin)

173.9 — ... Skin, site unspecified crosswalks to C44.9 (same definition).

You’ll also find fifth-character agreement between ICD-9 and ICD-10 for these codes, as follows:

0 — Unspecified malignant neoplasm of ...

1 — Basal cell carcinoma of ...

2 — Squamous cell carcinoma of ...

9 — Other specified malignant neoplasm of ...

Embrace the difference: The one significant change from ICD-9 to ICD-10 for these codes is the addition of a sixth character to further zero in on the lesion site.

For bilateral sites (eyelid, C44.1_; ear, C44.2_; upper limb, C44.6_; lower limb, C44.7_) you’ll have the following three choices for sixth characters:

1 — unspecified

2 — right

9 — left.

The sixth character definitions are a little different form some sites, as follows:

C44.3_ — ... other and unspecified parts of face

o 1 — unspecified

o 2 — nose

o 9 — other parts of face

C44.5_ — ... trunk

o 1 — anal/perianal

o 2 — breast

o 9 — other part of trunk.

There are no sixth character options for C44.0_, C44.4_, C44.8_ and C44.9_.