Oncology & Hematology Coding Alert

Plus, you’ll have new symptom codes to add to your coding cache.

You’ve got a new list of ICD-10-CM codes to consider for 2020. Anyone who’s played the diagnosis coding game knows these codes go into effect on October 1, 2019, so the 2020 tag is a bit misleading.

Don’t worry though. We’ve got the scoop for your oncology practice. Check out what you’ll need to know to remain spot-on in your diagnosis coding with 2020 codes.

Here’s the breakdown: ICD-10-CM changes for 2020, effective October 1, 2019, include:

• Seven (7) deletions,
• Forty-five (45) revisions, and
• Two-hundred seventy-two (272) additions.

1. First, Take Note of this New Travel Code

Suppose an immunosuppressed patient comes to your oncology office with travel planned to a particular country and region. The patient is worried about risk factors such as safe drinking water or disease prevention. The oncologist may counsel the patient and currently, you don’t have an accurate way to report the ICD-10-CM code for the counseling content.

After October 1, you can turn to Z71.84 (Encounter for health counseling related to travel).

Benefit: Using this code, your practice will be able to track these encounter types, says Melanie Witt, RN, MA, an independent coding consultant in Guadalupita, N.M.

2. Check Out These New Carcinoma In-Situ History Diagnoses

You have another Z code to apply after October 1.

According to the ICD-10-CM Meeting Minutes, “there are currently specific codes in ICD-10-CM for personal history of carcinoma in-situ of,” for example, “the breast (Z86.000), cervix uteri (Z86.001), and other site (Z86.008).” However, in some cases, oncologists may see patients with more than one type of cancer and history of in-situ neoplasms.

Additions: In this case, you’ll be able to report Z86.002 (Personal history of in-situ neoplasm of other and unspecified genital organs) after October 1. Similarly, you’ll have:

• Z86.003 (Personal history of in-situ neoplasm of oral cavity, esophagus and stomach)
• Z86.004 (Personal history of in-situ neoplasm of other and unspecified digestive organs)
• Z86.005 (Personal history of in-situ neoplasm of middle ear and respiratory system)
• Z86.006 (Personal history of melanoma in-situ)
• Z86.007 (Personal history of in-situ neoplasm of skin).

“This requested detail would enable better specificity and more accurate reporting of these diagnoses, and support assessment of risk for recurrence or potential need for future screening in particular cases,” the ICD-10-CM Meeting Minutes notes.

3. Take Note of Personal History of Tuberculosis

Along with a new code for latent tuberculosis carrier, you have a new code for a personal history of a latent tuberculosis infection. In this situation, after October 1, report Z86.15 (Personal history of latent tuberculosis infection).

4. Don’t Miss This BMI Detail

Reporting BMI is important in oncology as it relates to dosing, monitoring nutritional status over time and possible side effects of treatment, says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Associate Partner, Pinnacle Enterprise Risk Consulting Services, LLC. To be sure you’re reporting the accurate code, ICD-10-CM 2020 revises this code for BMI to add a “.0” after “50” in the code descriptor. So, it will be Z68.43 (Body mass index (BMI) 50.0-59.9, adult) on October 1, 2019 and beyond.

5. Diseases of the Blood Get New Additions

When you turn to “Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89),” you’ll find a new addition. Under “Other and unspecified disease of blood and blood-forming organs (D75),” you’ll find another disease code to capture D75.A (Glucose-6-phosphate dehydrogenase (G6PD) deficiency without anemia) specifically.

Under “Combined immunodeficiency (D81),” you’ll also find added codes for adenosine deficiencies. This change converts D81.3- to a parent code, which would now require a 5th digit. Your new options are:

• D81.30 for unspecified adenosine deficiency
• D81.31 for severe combined immunodeficiency due to adenosine deaminase deficiencies
• D81.32 for Adenosine deaminase 2 deficiency
• D81.39 for Other adenosine deaminase deficiency.

6. You’ll Be Able to Report Overlapping Quadrants

If the physician sees a patient with lump in the female breast, and the lump exists between anatomical sites, you might be confused as to what to report.

After October 1, you’ll have two options:

• N63.15 (Unspecified lump in the right breast, overlapping quadrants)
• N63.25 (Unspecified lump in the left breast, overlapping quadrants)

According to ICD-10-CM Meeting Minutes, these new codes “align the structure with the current codes for malignant neoplasm of breast (i.e., subcategory C50.8).”

7. Prepare for Cyclical Vomiting, Pyuria Additions

ICD-10-CM 2020 adds codes for cyclical vomiting with migraines, but you will most likely use new code R11.15 (Cyclical vomiting syndrome unrelated to migraine). This is for “unrelated to migraine,” so if the patient has recurring attacks of nausea, apply the code to report the symptom.

Another symptom captures abnormal urine results. Currently, you have R82.8 (Abnormal findings on cytological and histological examination of urine). However, after October 1, you’ll have two expanded options:

• R82.81 (Pyuria)
• R82.89 (Other abnormal findings on cytological and histological examination of urine).

If a patient has pyuria, then she has white blood cells in the urine. When a lab returns this finding, the patient may have a urinary tract infections (UTI). ICD-10-CM currently indexes pyuria to code (N39.0, Urinary tract infection, site not specified).

However, a patient could have other conditions, such as inflammation, kidney stone, tumor, etc. Or sterile pyuria, meaning a patient has the condition with no cause found (no tumor, no true urinary tract infection, and no stone disease).

“A practitioner’s office has requested new codes to identify this finding when clinical exploration is being done to determine the underlying diagnosis,” says ICD-10-CM Meeting Minutes.

Finally, a revised code for hyperuricosuria (R82.993) corrects its spelling.