Oncology & Hematology Coding Alert

Don’t forget ‘x’ placeholder when applying seventh character to postprocedural infection diagnosis.

The World Health Organization (WHO) recently published its list of the new ICD-10-CM 2019 codes, but they won’t go into effect until Oct. 1, 2018. Of these 320 new codes, 3 deleted codes and 172 revisions, you’ve got a smattering of oncology related diagnoses to add to coding cache.

Here’s what you need to know.

Zero-In on These Eye Lid Neoplasm Changes

In Chapter 2 of ICD-10-CM manual, entitled “Neoplasms,” there are a variety of changes to learn. However, before you worry too much, you’ll notice a pattern, many have “the addition of seventh character extensions,” says Angie Paine, COC, CPC, CPCO, CPB, CPMA, CPPM, CRC, CPC-I, CEMC, CRHC, consultant for Pinnacle Enterprise Risk Consulting Services located in Centennial, Colorado.

First of all, for melanoma and other malignant neoplasms of skin, note the following changes:

• Multiple sixth and seventh character extensions to specify upper or lower eye lid (C43.1, C44.1 & C4A.1).
• One new subcategory (C44.13 – Sebaceous cell carcinoma of skin of eyelid, including canthus) includes a six-character for left or right eyelid and seventh character extensions for upper or lower eye lid.
• With the addition of the new codes and seventh character extensions, 12 codes are now invalid.

For the in-situ neoplasms (D00-D09), you’ll have multiple seventh character extensions to specify upper or lower eye lid (D03.1 & D04.1).

Again, for benign neoplasms, except benign neuroendocrine tumors (D10-D36), you’ll have multiple seventh character extensions to specify upper or lower eye lid (D22.1 & D23.1).

Example: If a patient has a squamous cell carcinoma of the right upper eyelid, including canthus, report C44.1221 (Squamous cell carcinoma of skin of right upper eyelid, including canthus).

Heads up: Four codes are now invalid, including D23.11 for other benign neoplasm of skin of right eyelid.

Acquaint Yourself with These New Metabolic Disorder Codes

If your oncology patient has a metabolic problem, then check out these additions to metabolic disorders (E70-E88). They are:

• E72.81 (Disorders of gamma aminobutyric acid metabolism)
• E72.89 (Other specified disorders of amino-acid metabolism). This is a revision of E72.8 with the addition of the fifth character “9”.
• E75.26 (Sulfatase deficiency)
• E78.41 (Elevated Lipoprotein(a))
• E78.49 (Other hyperlipidemia).
• E88.02 (Plasminogen deficiency)

Heads up: With the addition of E78.41, code E78.4 (Other hyperlipidemia) has been revised to add the fifth digit of “9”.

Overhaul Reporting Infections Following a Procedure

You currently have T81.4 (Infection following a procedure) but the Excludes1 note is deleted. Instead, you’ll add:

     “Excludes2:
     obstetric surgical wound infection (O86.0-)
     postprocedural fever NOS (R50.82)
     postprocedural retroperitoneal abscess (K68.11)”

You’ll then add on these additions:

• T81.40- (Infection following a procedure, unspecified)
• T81.41- (Infection following a procedure, superficial incisional surgical site)
  Subcutaneous abscess following a procedure
  Stitch abscess following a procedure
• T81.42- (Infection following a procedure, deep incisional surgical site)
  Intra-muscular abscess following a procedure
• T81.43- (Infection following a procedure, organ and space surgical site)
  Intra-abdominal abscess following a procedure
  Subphrenic abscess following a procedure
• T81.44- (Sepsis following a procedure)
  Use Additional code to identify the sepsis
• 81.49- (Infection following a procedure, other surgical site).

Remember, to add a placeholder of “x” and add A (Initial encounter), D (Subsequent encounter), or S (Sequela) for the seventh character.

“These additions to the infection following a procedure diagnosis code offer further specificity regarding the location of the infection, as well as provide information related to the stage of treatment (initial, subsequent or sequela),” says Leah Fuller, CPC, Associate Consultant, Pinnacle Enterprise Risk Consulting Services, LLC, CO.

Finally, Make Note of These F, Y and Z Codes

Oncology patients using cannabis may be subject to these new codes:

• F12.23 (Cannabis dependence with withdrawal)
• F12.93 (Cannabis use, unspecified with withdrawal).

Additionally, there is a new subcategory for Z83.43 (Family history of other disorder of lipoprotein metabolism and other lipidemias). The new codes are:

• Z83.430 (Family history of elevated lipoprotein[a])
• Z83.438 (Family history of other disorder of lipoprotein metabolism and other lipidemia).