Oncology & Hematology Coding Alert

Don’t forget: This change in CPT^® guidelines correlated to the introduction of C84.7A (Anaplastic large cell lymphoma, ALK-negative, breast) to ICD-10-CM 2022, as “breast implant associated anaplastic large cell lymphoma (BIA-ALCL)” is the inclusion term for the code.

“The code carries with it instructions to use additional codes Z98.82 (Breast implant status) and Z98.86 (Personal history of breast implant removal). You should also refer to the ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 Section I.C.2.s,” says Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, senior consultant at Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado. The guideline tells you not to assign a complication code from chapter 19, such as a specific code from T85.4- (Mechanical complication of breast prosthesis and implant), when reporting codes for encounters such as these.

Answer 2: ICD-10-CM expanded D68.0 (Von Willebrand’s disease), or Von Willebrand disease (VWD) as the code set now names it, into 10 new codes.

The expansion of D68.0 for ICD-10-CM 2023 will allow you to report all the types of VWD the Centers for Disease Control and Prevention (CDC) and others in the medical field now recognize (Source: www.cdc.gov/ncbddd/vwd/facts.html), including VWD types 1, 2, and 3, and acquired VWD, along with codes for other VWD and unspecified type 2 VWD. The codes in question are:

• D68.00 (Von Willebrand disease, unspecified)
• D68.01 (… type 1)
• D68.020 (… type 2A)
• D68.021 (… type 2B)
• D68.022 (… type 2M)
• D68.023 (… type 2N)
• D68.029 (… type 2, unspecified)
• D68.03 (… type 3)
• D68.04 (Acquired von Willebrand disease)
• D68.09 (Other von Willebrand disease)

Answer 3: The major changes to E/M coding in 2023 will affect the following E/M services:

• 99282-99285 (Emergency department visit …)
• 99242-99245 (Office or other outpatient consultation …)
• 99221-99223 (Initial hospital inpatient or observation care, per day …)
• 99231-99233 (Subsequent hospital inpatient or observation care, per day …)
• 99234-99236 (Hospital inpatient or observation care… including admission and discharge on the same date …)

The purpose of the changes is to bring these codes in line with the way you calculate levels for 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/ established patient …).

Since Jan. 1, 2021, you’ve had to code E/M services in one of two ways. For 99202-99215, you have calculated levels by meeting or exceeding two of the three medical decision making (MDM) elements: the number and complexity of problems addressed at the encounter, the amount and/or complexity of data to be reviewed and analyzed, and the risk of complications and/ or morbidity or mortality of patient management. You’ve also had the option of assigning a level based on the total time the provider has spent on face-to-face and non-face-to-face activities as defined by CPT^® guidelines on the same date as the encounter.

However, for the other E/M service categories listed above, you’ve been calculating E/M levels with the old 1995/1997 documentation guidelines — using history, exam, and/or MDM — or time, when appropriate, by applying the 50 percent counselling and/or coordination of care guideline.

Now, CPT^® 2023 will let you use MDM or time to calculate level of service for all E/M services for which levels are a criteria for code selection.

Don’t forget: In keeping with the level one office/outpatient E/M code deletions of 2021, CPT^® has deleted the lowest level office outpatient consultation code (99241) to align with the four levels of MDM in 2023. For all E/M codes, with the exception of 99282-99285, which you’ll calculate on MDM alone, you will now have the option to code based on MDM or total time, whichever is more advantageous to the provider.

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