ICD 10 Coding Alert

Check the guidelines before reporting ectopic tissue neoplasms.

When documentation shows pancreatic cancer of overlapping sites, you currently turn to 157.8 -- the "other specified sites" code for pancreatic neoplasms. When ICD-10-CM replaces ICD-9-CM, you'll have to get used to a new approach for reporting these neoplasms of overlapping sites.

ICD-9-CM Code

• 157.8, Malignant neoplasm of other specified sites of pancreas

ICD-10-CM Codes

• C25.7, Malignant neoplasm of other parts of pancreas
• C25.8, Malignant neoplasm of overlapping sites of pancreas

ICD-9-CM coding rules: You should use 157.8 for a primary malignant neoplasm of pancreatic sites for which there is no more specific code. For instance, you use this code for neoplasms of the pancreas neck. Coding guidelines also instruct you to use the code for ectopic pancreatic tissue and "Malignant neoplasm of contiguous or overlapping sites of pancreas whose point of origin cannot be determined."

ICD-10-CM changes: Code 157.8 crosses to more than one code. First is "other" code C25.7. As with ICD-9-CM, the "other" code is appropriate for a primary malignant pancreas neoplasm for which there is no more specific code (including neck of pancreas).

Unlike ICD-9-CM, ICD-10-CM includes a separate code for "overlapping sites," C25.8. (See "Coder tips" below for more on proper use of this code.)

Another difference is that ICD-9-CM includes ectopic pancreatic tissue under "other" code 157.8. A note with ICD-10-CM Chapter 2 (Neoplasms) states, "Malignant neoplasms of ectopic tissue are to be coded to the site mentioned, e.g., ectopic pancreatic malignant neoplasms are coded to pancreas, unspecified (C25.9)."

Documentation: In addition to choosing the appropriate neoplasm code, ICD-10-CM also instructs you to "Use additional code to identify: alcohol abuse and dependence (F10.-)." To allow you to comply with this instruction, the physician should be sure to document the patient's level of alcohol use.

Coder tips: Remember that C25.8 refers to "overlapping sites," not "multiple sites." So if the patient has two primary malignant neoplasms in the pancreas, but the two don't overlap, C25.8 would not be appropriate. As ICD-10-CM Chapter 2 (Neoplasms) instructs, "A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned."

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update. Currently, the proposed implementation date is Oct. 1, 2014.