Oncology & Hematology Coding Alert

Follow instructions to include code for current neoplasm and family history, too.

You can expect a direct crosswalk of a few ICD-9-CM codes to ICD-10-CM for reporting certain genetic susceptibility test results.

ICD-9-CM Codes:

V84.01, Genetic susceptibility to malignant neoplasm of breast

V84.02, Genetic susceptibility to malignant neoplasm of ovary

V84.03, Genetic susceptibility to malignant neoplasm of prostate

V84.04, Genetic susceptibility to malignant neoplasm of endometrium

V84.09, Genetic susceptibility to other malignant neoplasm

ICD-10-CM Codes:

Z15.01, Genetic susceptibility to malignant neoplasm of breast

Z15.02, Genetic susceptibility to malignant neoplasm of ovary

Z15.03, Genetic susceptibility to malignant neoplasm of prostate

Z15.04, Genetic susceptibility to malignant neoplasm of endometrium

Z15.09, Genetic susceptibility to other malignant neoplasm

ICD-9-CM coding rules: ICD-9-CM applies the following rules to all codes in the V84 range:

Includes: Confirmed abnormal gene

Use additional code, if applicable, for any associated family history of the disease (V16-V19)

Excludes: Chromosomal anomalies (758.0-758.9).

For those codes beginning with V84.0, ICD-9-CM instructs:

Code first, if applicable, any current malignant neoplasms (140.0-195.8, 200.0-208.9, 230.0-234.9)

Use additional code, if applicable, for any personal history of malignant neoplasm (V10.0-V10.9).

ICD-10-CM changes: You’ll find very similar instructions in ICD-10-CM, although of course the codes differ. The instructions for the Z15 range state:

Includes: Confirmed abnormal gene

Use additional code, if applicable, for any associated family history of the disease (Z80-Z84)

Excludes1: Chromosomal anomalies (Q90-Q99)

Instructions for those codes beginning with Z15.0 state:

Code first, if applicable, any current malignant neoplasm (C00-C75, C81-C96)

Use additional code, if applicable, for any personal history of malignant neoplasm (Z85.-).

Documentation: To choose the most appropriate code, you’ll need to know which type of malignant neoplasm the patient has a genetic susceptibility to: breast, ovary, prostate, endometrium, or another kind that doesn’t have a specific code.

Coder tips: Neither ICD-9-CM nor ICD-10-CM distinguishes the diagnosis codes based on the specific genetic test. For instance, physicians may select Z15.01 or Z15.02 based on BRCA-1 and/or BRCA-2 positive results from a test.

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 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.