Oncology & Hematology Coding Alert

Check the index before reporting carcinoma in situ.

You can expect to have a few more coding options for ovarian neoplasms once ICD-10-CM replaces ICD-9-CM. The key to identifying the most specific ICD-10-CM code will be knowing which ovary is affected.

ICD-9-CM Code

·         183.0, Malignant neoplasm of ovary

ICD-10-CM Codes

·         C56.1, Malignant neoplasm of right ovary

·         C56.2, Malignant neoplasm of left ovary

·         C56.9, Malignant neoplasm of unspecified ovary

ICD-9-CM coding rules: You currently have one code for a malignant ovarian neoplasm. ICD-9-CM guidelines for 183.0 instruct you to use an additional code to identify any functional activity, if known.

ICD-10-CM changes: As with many other bilateral organs, ICD-10-CM provides a way for you to distinguish which ovary is affected — right or left. If the medical record doesn’t identify right or left, you’ll have to use the “unspecified” ICD-10-CM code for the ovary (C56.9). Like ICD-9-CM, ICD-10-CM includes a note to “Use additional code to identify any functional activity.”

Documentation: Physicians will need to document whether the neoplasm affects the right or left ovary to take advantage of ICD-10-CM’s greater specificity. The oncologist should already be including this information as part of a thorough medical record. So as you prepare for the switch to ICD-10-CM, you just need to be sure you are able to capture the information quickly for coding.

Coder tips: The ICD-9-CM guidelines indicate that 183.0 is inappropriate for a neoplasm of Douglas’ cul-de-sac (158.8, Malignant neoplasm of specified parts of peritoneum) or carcinoma in situ (233.39, Carcinoma in situ, other female genital organ).

ICD-10-CM 2013 doesn’t include similar notes with C56.-, but that doesn’t mean you should use this range for those diagnoses. Under ICD-10-CM, a Douglas’ cul-de-sac neoplasm is coded to C48.1 (Malignant neoplasm of specified parts of peritoneum). The appropriate code for a carcinoma in situ of the ovary is D07.39 (Carcinoma in situ of other female genital organs).

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. ICD-9 codes will no longer be “accepted for claims after October 1, 2014. ICD-10 codes will not be recognized or accepted on claims prior to October 1, 2014. Claims cannot contain both ICD-9 codes and ICD-10 codes,” explained Sarah Shirey-Losso from the Provider Billing Group of the Center for Medicare in the “Begin Transitioning to ICD-10 in 2013” National Provider Call on April 18, 2013.

Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.