Oncology & Hematology Coding Alert

ICD-9-CM and ICD-10-CM take different approaches to this diagnosis.

At first glance, brain cancer codes appear to have a direct crossover from ICD-9-CM to ICD-10-CM. Take a closer look at the “includes” and “excludes” lists, though, and you’ll see some important differences.

The code ranges are in the table below:

ICD-9-CM coding rules: ICD-9-CM groups malignant neoplasms of the brain under 191.x. The codes vary based on anatomic area.

ICD-10-CM changes: Comparing ICD-9-CM to ICD-10-CM brain neoplasm codes reveals almost identical groupings. One change to watch relates to malignant neoplasms of the fourth cerebral ventricle. The ICD-9-CM neoplasm table indexes “ventricle (cerebral) (floor) (fourth) (lateral) (third)” to 191.5, the code for ventricle neoplasm. In contrast, ICD-10-CM instructs you to use brain stem code C71.7 for a malignant neoplasm of the fourth cerebral ventricle.

You’ll also notice a difference in the wording between crosswalked codes 191.8 (other parts) and C71.8 (overlapping sites). Note that ICD-9-CM code 191.8 (other) is also appropriate for contiguous overlapping neoplasms.

Documentation: The similarities between the ICD-9-CM and ICD-10-CM brain neoplasm codes means your documentation needs won’t change when ICD-10-CM is implemented. The physician should document the location of the neoplasm and specify whether it is primary to ensure you can choose the most specific code.

Coder tips: Some of the terms in the ICD-10-CM “includes” lists differ from the ones you’ll find under ICD-9-CM. For instance, for 191.0 ICD-9-CM lists basal ganglia, cerebral cortex, corpus striatum, globus pallidus, hypothalamus, and thalamus. For cross-code C71.0, ICD-10-CM lists only malignant neoplasm of supratentorial NOS. Supratentorial refers to the area of the brain above the tentorium cerebelli, a membrane layer just above the cerebellum part of the brain.

To choose the appropriate code for your case, check the index neoplasm table and the tabular list. If you can’t match the terms in the documentation to the terms in ICD-10-CM, check with the physician to be sure you’re choosing the proper code.

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.