ICD 10 Coding Alert

This update bucks the trend of expanding into multiple codes.

Here’s a surprise: you’ll encounter fewer specific codes in ICD-10 than ICD-9 for malignant esophageal neoplasms. You may have noticed that many conditions have a direct crosswalk or an expansion to numerous, more-specific codes when ICD-10 goes into effect on Oct. 1, 2015, but the opposite seems to be the case for malignant esophageal tumors.

Chapter 2 of ICD-10 classifies neoplasms primarily by site (topography), with broad groupings for behavior, malignant, in situ, benign, etc. You should use The Table of Neoplasms to identify the correct topography code.

Lesser Redundancies Bring Clarity

When you report malignant tumors for the esophageal region in ICD-9, you have choice from among eight ICD-9 codes, depending upon the site of malignancy.

You report 150.0 (Malignant neoplasm of cervical esophagus), 150.1 (Malignant neoplasm of thoracic esophagus) and 150.2 (Malignant neoplasm of abdominal esophagus) if the documentation indicates the malignancy has been seen in the cervical, thoracic or abdominal sections of the esophagus. These codes use the “cervical, thoracic, abdominal” terminology, which is repetitive with the codes that distinguish the upper, middle, and lower third of the esophagus.

In ICD-10, these three (150.0, 150.1 and 150.2) codes have been dropped as they have the same interpretation as the ICD-9 codes 150.3 (Malignant neoplasm of upper third of esophagus), 150.4 (Malignant neoplasm of middle third of esophagus), and 150.5 (Malignant neoplasm of lower third of esophagus), and as such, are redundant.

So, ICD-10 has provided direct crosswalks with C15.3 (Malignant neoplasm of upper third of esophagus) replacing 150.3, C15.4 (Malignant neoplasm of middle third of esophagus) directly matching with 150.4 and C15.5 (Malignant neoplasm of lower third of esophagus) having a direct crosswalk from 150.5.

Provision for Contiguous Sites Keeps Things Simple

Currently, you report any other specified malignancy of the esophagus with 150.8 (Malignant neoplasm of other specified part of esophagus). ICD-10 does not present a direct word-to-word crosswalk but has a corresponding code C15.8 (Malignant neoplasm of overlapping sites of esophagus). This code will serve the same purpose because ICD-9 has a text note following 150.8 indicating that the code includes, “Malignant neoplasm of contiguous or overlapping sites of esophagus whose point of origin cannot be determined.”

Unspecified Site Gets Direct Crossover

In ICD-9, you have been reporting 150.9 (Malignant neoplasm of esophagus unspecified site) for all malignant neoplasms of unspecified site. In ICD-10, you get a direct corresponding code C15.9 (Malignant neoplasm of esophagus, unspecified) for reporting the same.

Note: According to ICD-9, the malignancies reported above exclude carcinomas in situ (230.1-230.9). However, you can expect a direct crosswalk for esophageal carcinoma “in situ” also when you change from ICD-9 to ICD-10. Prepare to change from 230.1 (Carcinoma in situ of esophagus) to D00.1 (Carcinoma in situ of esophagus) when ICD-10 goes into effect next fall.