Oncology & Hematology Coding Alert

Don't miss the difference between 'other' and 'unspecified.'

Pinpointing anatomic location is crucial to correct ICD-9 coding for female patients with breast cancer. Simplify the job with this helpful 174.x (Malignant neoplasm of female breast) visual aid.

Watch for Other 174.x Opportunities

Axillary tail: Code 174.6 (... axillary tail) is appropriate for neoplasms of the area that reaches from the upper breast up through the underarm area.

Other: Use 174.8 (... other specified sites of female breast) if the oncologist's documentation refers to locations such as the following without offering more specifics:

• Ectopic sites
• Inner breast
• Lower breast
• Contiguous or overlapping sites whose origin can't be
• determined
• Midline of breast
• Outer breast
• Upper breast.

Unspecified: If the documentation doesn't specify a site, 174.9 (Breast [female], unspecified) is appropriate. Think of "unspecified" the same as you would for "not otherwise specified" or "NOS," says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMC, CMC, the CEO of Terry Fletcher Consulting in Laguna Beach, Calif. In other words, the physician's documentation does not provide enough information to assign a more specific code.

ICD-10: Documentation of location will be even more crucial when ICD-10 goes into effect in 2013. Choosing the most specific ICD-10 2010 breast cancer code requires knowing which breast and what location for both male and female patients. For example, check out these six-figure codes:

• C50.412 -- Malignant neoplasm of upper-outer quadrant of left female breast
• C50.422 -- Malignant neoplasm of upper-outer quadrant of left male breast.››

"Much of the detail contained in ICD-10-CM is already in the medical record documentation -- it's just not being utilized because it's not needed for ICD-9 coding," according to Sue Bowman, RHIA, CCS, director of coding policy and compliance with the American Health Information Management Association (AHIMA), speaking at a CMS Open Door Forum.

And experts agree that if an oncologist is treating a neoplasm, he should have identified the location and documented it.

Resource: You can download ICD-10 2010 files at www.cdc.gov/nchs/icd/icd10cm.htm#10update.