Oncology & Hematology Coding Alert

'Other specified' and 'unspecified' NHL fall under different codes in ICD-10.

When you start using ICD-10 in 2013, the new code set won't always offer a simple one-to-one relationship to the old codes. Often, you'll have additional options that may require tweaking the way your physician documents a service and the way a coder reports it.

Consider this: Under ICD-9, your go-to code for unspecified or other specified non-Hodgkin lymphoma (NHL) is 202.8x (Other lymphomas). So 202.8x serves as both an NEC (not elsewhere classifiable/other specified) and NOS (not otherwise specified/unspecified) code.

ICD-10 change: ICD-10 does things a little differently by offering one code range for NHL NEC and another code range for NHL NOS.

NEC: ICD-10 2011 includes C85.8- (Other specified types of non-Hodgkin lymphoma) for reporting NHL when the physician documents the type but ICD-10 doesn't offer a more specific code appropriate for that diagnosis. To start preparing to use this code range, take a close look at the ICD-10 codes available for specified types of NHL. That way, you'll be able to identify more quickly when the oncologist documents a type that doesn't match available specific codes. And, just as with ICD-9, be sure to start your ICD- 10 code search in the index for terms that match your documentation. That will help you identify the most specific code for your case.

NOS: ICD-10 2011 includes C85.9- (Non-Hodgkin lymphoma, unspecified) for use when the oncologist documents NHL without stating the specific type.

Fifth digit: The ICD-10 2011 and ICD-9 2011 NHL codes require a fifth digit to be complete. The fifth digit sub-classification is based on the lymph nodes involved. The ICD-10 and ICD-9 options are similar, with one important difference. You will have separate ICD-10 options for unspecified site (0) and extranodal and solid organ sites (9). In ICD-9, the two are both reported using fifth digit 0.

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically, always use the codes and guidelines effective for the relevant date of service). Learn more about ICD-10 at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.