Oncology & Hematology Coding Alert

Prepare to implement revisions in your Hodgkin lymphoma diagnosis coding.

The CDC has posted a preliminary list of ICD-10-CM changes for October 1 (aka ICD-10-CM 2017), and just in case you don’t have time right now to sort through about 2,000 new codes, here are some relevant to interventional oncology practices.

The five-year freeze coders and providers have enjoyed with the ICD-10-CM system is about to end on October 1, 2016. You can anticipate significant changes going by the information CMS released for public review. If accepted, alterations will include the following:

• 1,943 new codes, 422 revisions, and 305 deletions for ICD-10-CM
• 3,651 new codes, 351 revisions, and 313 deletions for ICD-10-PCS.

Plus: The ICD-10 Coordination and Maintenance Committee reviewed proposals for updating ICD-10-CM and PCS. If approved, these would be included in the October 1, 2017, classification system addenda for FY 2018.

Updates allow new or revised codes to encompass recent advances and trends in healthcare. The new codes have arrived sooner than many experts expected.

The committee reviewed 24 diagnosis proposals, such as:

• Congenital sacral dimple: The American Academy of Pediatrics proposed a new congenital code so this condition can be accurately tracked.
• Zika virus was discussed, regarding a new code being created. NCHS/CDC is proposing it for inclusion in the 10/1/16 addenda, which would be consistent with the World Health Organization (WHO).

Expect to Go Beyond Classical in Hodgkin Lymphoma

An important change you can anticipate later this year is for the diagnosis codes for Hodgkin lymphoma. Later this year, the diagnosis codes C81.10 (Nodular sclerosis classical Hodgkin lymphoma, unspecified site) to C81.79 (Other classical Hodgkin lymphoma, extranodal and solid organ sites) will undergo a uniform elimination of the term ‘classical’ in the code descriptors.

What this means? This means codes C81.10 to C81.79 will have revised descriptors. Check these changes in the examples below.

• C81.10, Nodular sclerosis classical Hodgkin lymphoma, unspecified site
• C81.11, Nodular sclerosis classical Hodgkin lymphoma, lymph nodes of head, face, and neck
• C81.15, Nodular sclerosis classical Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
• C81.19, Nodular sclerosis classical Hodgkin lymphoma, extranodal and solid organ sites
• C81.20, Mixed cellularity classical Hodgkin lymphoma, unspecified site
• C81.22, Mixed cellularity classical Hodgkin lymphoma, intrathoracic lymph nodes
• C81.30, Lymphocyte depleted classical Hodgkin lymphoma, unspecified site
• C81.31, Lymphocyte depleted classical Hodgkin lymphoma, lymph nodes of head, face, and neck
• C81.46, Lymphocyte-rich classical Hodgkin lymphoma, intrapelvic lymph nodes
• C81.47, Lymphocyte-rich classical Hodgkin lymphoma, spleen

How does this change impact your choice of codes? These revisions for the ICD-10-CM codes for Hodgkin lymphoma do not impact the available choices you have to report this condition. The choice of codes will continue to be governed by the histological subtype of Hodgkin lymphoma.

Why the revisions? These revisions will align the codes to the accepted classification of Hodgkin lymphoma. This revision in codes C81.10 to C81.49 aligns the codes to the widely accepted classification of Hodgkin lymphoma by the World Health Organization (WHO) (Refer to the box). The revised descriptors retain the specificity for each histological type of classical Hodgkin lymphoma.

Make Room for All Subtypes in Hodgkin Lymphoma

The proposed revisions to the ICD-10-CM codes will encompass all groups in the histological classification.

Does this add specificity? These revisions will introduce more specificity to the following codes:

• C81.70, Other classical Hodgkin lymphoma, unspecified site
• C81.71, Other classical Hodgkin lymphoma, lymph nodes of head, face, and neck
• C81.72, Other classical Hodgkin lymphoma, intrathoracic lymph nodes
• C81.73, Other classical Hodgkin lymphoma, intra-abdominal lymph nodes
• C81.74, Other classical Hodgkin lymphoma, lymph nodes of axilla and upper limb
• C81.75, Other classical Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
• C81.76, Other classical Hodgkin lymphoma, intrapelvic lymph nodes
• C81.77, Other classical Hodgkin lymphoma, spleen
• C81.78, Other classical Hodgkin lymphoma, lymph nodes of multiple sites
• C81.79, Other classical Hodgkin lymphoma, extranodal and solid organ sites

The elimination of the term ‘classical’ in the codes C81.70 to C81.79 makes room for the nodular lymphocyte predominant type of Hodgkin lymphoma, which is the second group of Hodgkin lymphoma in the WHO classification (See box).

Start preparing: In the next few months, make sustained efforts to refine ICD-10-CM coding practices. Enlist the revisions relevant to your practice and train your staff.

Be warned: The list is not yet final. The CDC will post the final addendum in June.

Resource: To review the complete list, head to ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt.

Stay tuned: We’ll keep you posted once the final addendum comes out. The final addenda with additions/revisions will be published in June at www.cms.hhs.gov. You can find the ICD-10-CM addendum at www.cdc.gov/nchs/icd/icd10cm.htm. “The code lists that have been posted on the CMS and CDC websites are NOT the final list. The Addenda to be published in June is the complete, final list of code changes going into effect this October,” says Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director of Coding Policy and Compliance at AHIMA.

Editor’s note: Watch this space for updates in the next few issues of Oncology Coding Alert.