Oncology & Hematology Coding Alert

Choosing your fifth character requires a little more detective work under the new code set.

Whether anaplastic large cell lymphoma is ALK-positive or ALK-negative can change a patient’s prognosis. Under ICD-10-CM, you’ll be able to use your coding to reflect this important information.

ICD-9-CM Code:

• 200.65, Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb

ICD-10-CM Codes:

• C84.65, Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb
• C84.75, Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb

The diagnosis: Anaplastic large cell lymphoma (ALCL) is a T-cell non-Hodgkin’s lymphoma. The ALK referenced in the ICD-10-CM codes is anaplastic lymphoma kinase protein. ALK-negative ALCLs are prone to being more aggressive than ALK-positive ALCLs. Relapse is also more likely with ALK-negative ALCLs.

ICD-9-CM coding rules: A single ICD-9-CM code, 200.61, applies to both ALK-positive and ALK-negative ALCL.

ICD-10-CM changes: ICD-10-CM requires you to identify whether the ALCL is ALK-positive or ALK-negative.

Documentation: For you to choose the appropriate code, the medical record needs to specify ALK-positive or ALK-negative. You also will need to know the specific lymph node sites affected, as explained in more detail below.

Coder tips: The featured ICD-9-CM and ICD-10-CM codes are specific to ALCL of lymph nodes of the inguinal region (groin and lower abdomen) and lower limb. It is the fifth character that identifies the site.

Under ICD-9-CM, you have a total of eight fifth-digit options for 200.6x based on the location of the affected lymph nodes:

• 0, unspecified site, extranodal and solid organ sites
• 1, lymph nodes of head, face, and neck
• 2, intrathoracic lymph nodes
• 3, intra-abdominal lymph nodes
• 4, lymph nodes of axilla and upper limb
• 5, lymph nodes of inguinal region and lower limb
• 6, intrapelvic lymph nodes
• 7, spleen
• 8, lymph nodes of multiple sites.

ICD-10-CM’s fifth-character options are similar, but you have an additional choice. Unlike ICD-9-CM, ICD-10-CM separates unspecified site from extranodal and solid organ sites. For both C84.6- and C84.7-, the fifth characters identify the following anatomic areas:

• 0, unspecified site
• 1, lymph nodes of head, face, and neck
• 2, intrathoracic lymph nodes
• 3, intra-abdominal lymph nodes
• 4, lymph nodes of axilla and upper limb
• 5, lymph nodes of inguinal region and lower limb
• 6, intrapelvic lymph nodes
• 7, spleen
• 8, lymph nodes of multiple sites
• 9, extranodal and solid organ sites.

Remember: 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.