Medicare Compliance & Reimbursement

Tried-and-true tactics get your doctor's documentation on board with these more specific codes.

You're in for a parade of denials if you don't master the barrage of lymphoma changes that ICD-9 2008 has in store for you.

Prepare now: You and your doctors should start the mental shift so you'll be ready when the new ICD-9 codes go into effect Oct. 1, 2007. 1. Blast Out Of Your 202.80 Rut In 2008 If you've got carpal tunnel from reporting 202.80 (Other lymphomas; unspecified site, extranodal and solid organ sites) over and over again, prepare to exercise some new lymphoma coding muscles with ICD-9 2008.

You'll have 54 new lymphoma codes to master:

• marginal zone lymphoma (200.30-200.38)
• mantle cell lymphoma (200.40-200.48)
• primary central nervous system lymphoma (200.50-200.58)
• anaplastic large cell lymphoma (200.60-200.68)
• large cell lymphoma (200.70-200.78)
• peripheral T-cell lymphoma (202.70-202.78).
 
Reporting 202.80 less often is a benefit, but all of these new lymphoma codes may cause some hardships, says Erin Goodwin, CPC, CMC, reimbursement and coding professional for South Carolina Oncology Associates.

Reality: Your providers' documentation must offer the details you need to choose among these new codes. The trick is finding the middle ground between the doctor not documenting enough information and making his documentation so specific that you have a hard time choosing the most appropriate diagnosis code, Goodwin says.

What to do: Once you get the final list of new codes, give your providers a job aid with the more specific codes, Goodwin says. Your doctors may not know what information you need for each diagnosis, so you can show them the detail you need and point out that documenting those specifics helps you do your job more efficiently and helps satisfy payors when they ask for medical records, she says.

The provider's documentation should offer enough detail to allow you to choose among the following fifth-digit options:

• 0--unspecified site, extranodal, and solid organ sites
• 1--lymph nodes of head, face, and neck
• 2--intrathoracic lymph nodes
• 3--intra-abdominal lymph nodes
• 4--lymph nodes of axilla and upper limb
• 5--lymph nodes of inguinal region and lower limb
• 6--intrapelvic lymph nodes
• 7--spleen
• 8--lymph nodes of multiple sites. Each type of lymphoma may require different treatment, says independent consultant Margaret Hickey in New Orleans. So with these new, more specific diagnosis codes, you'll have to be more careful to align each treatment with the appropriate diagnosis code.

Resource: You can find behind-the-scenes information on the new ICD-9 codes in the ICD-9 Committee minutes at www.cdc.gov/nchs/about/otheract/icd9/maint/maint.htm.

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