Oncology & Hematology Coding Alert

But you’ll have to continue the search if documentation shows hemorrhagic disorder.

Added specificity is the bogeyman of ICD-10-CM preparation. But you can take the fear out of the transition by knowing which common codes will fracture into multiple options and remembering the index and tabular list will steer you to the proper code. Here’s what to expect for hypercoagulation code 289.81.

ICD-9-CM Code

289.81, Primary hypercoagulable state

ICD-10-CM Codes

• D68.51, Activated protein C resistance
  Factor V Leiden mutation
• D68.52, Prothrombin gene mutation
• D68.59, Other primary thrombophilia
  
• Antithrombin III deficiency, hypercoagulable state NOS, primary hypercoagulable state NEC, primary thrombophilia NEC, protein C deficiency, protein S deficiency, thrombophilia NOS

D68.61, Antiphospholipid syndrome

• Anticardiolipin syndrome, antiphospholipid antibody syndrome

D68.62, Lupus anticoagulant syndrome

• Lupus anticoagulant, presence of systemic lupus erythematosus [SLE] inhibitor

Diagnosis: Patients with a hypercoagulable state are at increased risk for blood clots. Remember that "hyper-" means over or excess. "Coagulable" means capable of being clotted.

ICD-9-CM coding rules:

CMS has finalized the ICD-10-CM compliance date of Oct. 1, 2014. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.

ICD-9-CM includes a long list of diagnoses under 289.81: activated protein C resistance, antiphospholipid antibody syndrome, antithrombin III deficiency, factor V Leiden mutation, lupus anticoagulant with hypercoagulable state, protein C deficiency, protein S deficiency, prothrombin gene mutation, systemic lupus erythematosus [SLE] inhibitor with hypercoagulable state.

ICD-10-CM changes: That long list of diagnoses is split among five different codes under ICD-10-CM, as shown in the code list above.

Documentation: To allow you to choose the most specific ICD-10-CM code, the physician should document the specific primary hypercoagulable state type. If you don’t have that information, you’ll have to use "other" code D68.59.

Coder tips: Take the time to review the Excludes list with each code before you finalize your claim. If the documentation indicates a "secondary" hypercoagulable state or notes a hemorrhagic disorder with the diagnosis, expect the ICD-10-CM index and tabular list to point you to another code option. For instance, hemorrhagic disorder distinguishes D68.312 (Antiphospholipid antibody with hemorrhagic disorder) from D68.61.

Remember: