Oncology & Hematology Coding Alert

And note numerous new contact dermatitis codes for your patients with stomas.

With all the breakthroughs that have occurred with cellular therapy in recent years, it’s not surprising that ICD-10-CM has now updated to allow you to document the applicable conditions for your cancer patients. But there are plenty of other non-cell therapy changes for you to master, too.

So, get out your real or virtual highlighter and note these 2022 code revisions effective as of Oct. 1, 2021.

Catch These Chapter 2 Highlights

“One big revision concerns the change to the Code also note that accompanies the C25.X (Malignant neoplasm of pancreas) codes,” says Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, Senior Consultant at Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado.

Originally, the Code also note indicated exocrine pancreatic insufficiency (K86.81) must be coded. But the CDC has now added the words “if applicable,” which “resolves confusion that it is only assigned if it is applicable, not an assumption it is always present,” according to Pritchett.

New codes in this chapter include C79.63 (Secondary malignant neoplasm of bilateral ovaries), which now gives you a bilateral option, and C84.7A (Anaplastic large cell lymphoma, ALK-negative, breast). “This code comes with the synonym of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and Use additional notes that tell you to identify breast implant status (Z98.82) and personal history of breast implant removal (Z98.86),” says Pritchett.

Expand Your Anemia Options

Here, the big change involves an expansion of the D55.- (Anemia due to enzyme disorders) codes, and a corresponding change to the synonyms accompanying the codes. Beginning October 1, you’ll be able to use:

• D55.21 (Anemia due to pyruvate kinase deficiency)
• D55.29 (Anemia due to other disorders of glycolytic enzymes)

“This change — to expand and account for the deficiency status of each that must be included as a specific cause ‘due to’ — is notable,” says Pritchett.

New notes also tell you to no longer use hemolytic nonspherocytic (hereditary) anemia, type II, hexokinase deficiency anemia, pyruvate kinase (PK) deficiency anemia, or triose-phosphate isomerase deficiency anemia as synonyms for D55.2 (Anemia due to disorders of glycolytic enzymes) as it is not a valid code. Instead, if your provider documents pyruvate kinase anemia, or PK deficiency anemia, you will now code that to D55.21, while you will code hexokinase deficiency anemia and triose-phosphate isomerase deficiency anemia to D55.29.

Note These T-Cell Therapy Changes

The cellular therapy changes begin with revisions to the G92 (Toxic encephalopathy) codes, which could possibly affect your coding if you have patients undergoing forms of T-cell therapy for cancer. That’s because one of the side effects of the therapy is immune effector cell-associated neurotoxicity syndrome (ICANS), which now gets its own parent code (G92.0). You’ll be able to specify the ICANS grade (1-5 or unspecified) using the appropriate fifth character.

Important additions to this code group also include the instructional notes that accompany both the parent code and the ICANS code specifically. “If the patient’s ICANS is caused by immune effector cellular (IEC) therapy, especially chimeric antigen receptor (CAR-T) cell therapy, you will need to identify that using another new code, T80.82 (Complication of immune effector cellular therapy),” Pritchett notes.

Other new conditions in the G92 group include an unspecified toxic encephalopathy code (G92.9) and G92.8 (Other toxic encephalopathy), which you will use if the patient has developed toxic encephalitis. As this condition is drug induced, you will need to identify the specific therapy from the T36-T50 (Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances) code group per the G92.8 and G92.9 Code first and Use additional code notes.

“Additionally, ICD-10-CM has also added Code also notes instructing you to code associated signs/symptoms, such as cerebral edema (G93.6) and convulsions (R56.9),” Pritchett points out.

And don’t forget these new codes from Chapter 21: You also have some new related personal history of medical treatment codes that you can use once a patient has completed cellular therapy. They include new parent code Z92.85 (Personal history of cellular therapy), which is subdivided to Z92.850 (Personal history of Chimeric Antigen Receptor T-cell therapy), Z92.858 (Personal history of other cellular therapy), and Z92.859 (Personal history of cellular therapy, unspecified).

Get More Specific With Gastric Metaplasia

The big news for oncology coding in this chapter is that gastric intestinal metaplasia gets a parent code: K31.A-. Here, “your documentation will need to specify the grade of dysplasia if applicable and the organ involved if the patient has the condition without dysplasia,” Pritchett cautions.

So, for example, you can now code gastric intestinal metaplasia without dysplasia, involving the body (corpus) to K31.A12, while you’ll be able to use K31.A14 for gastric intestinal metaplasia without dysplasia, involving the cardia. For gastric intestinal metaplasia with dysplasia, you’ll able to add specificity with codes for low (K31.A21), high (K31.A22), and unspecified (K31.A29) grades of dysplasia.

And if your provider diagnoses gastric intestinal metaplasia indefinite for dysplasia or another form of gastric intestinal metaplasia not otherwise specified, you’ll be able to use K31. A0 (Gastric intestinal metaplasia, unspecified).

Initiate this Irritant Contact Dermatitis Codeset After Oct. 1

The introduction of new parent code L24.B (Irritant contact dermatitis related to stoma or fistula) will also affect your diagnosis coding after October 1. That’s because its introduction has led to numerous other codes that you’ll be able to use when the irritation affects stoma, fistula, colostomy, gastrostomy, and jejunostomy tubes. “This is a notable change for oncology due to the side effects a patient may have from an artificial opening,” Pritchett notes.

Key new codes for oncology in this chapter include:

• L24.B0 (Irritant contact dermatitis related to unspecified stoma or fistula)
• L24.B1 (Irritant contact dermatitis related to digestive stoma or fistula)
• L24.B2 (Irritant contact dermatitis related to respiratory stoma or fistula)
• L24.B3 (Irritant contact dermatitis related to fecal or urinary stoma or fistula)

But before you use them, be sure to pay attention to the synonyms for each code along with the Use additional code note that tells you to “identify any artificial opening status (Z93.-), if applicable, for contact dermatitis related to stoma secretions.”

Track This TA-TMA Change

Another new code related to cell therapy is M31.11 (Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]), also known by its synonym transplant-associated thrombotic microangiopathy (TA-TMA). Here, “the notable changes are the addition of ‘Code first’ complications of bone marrow or stem cell transplantation,” Pritchett notes.

“Another notable change is the addition of the Use additional code instruction to identify the specific organ dysfunction related to the thrombotic microangiopathy,” such as graft versus host disease (D89.81-) and hemolytic uremic syndrome (D59.3). “This is very important for documentation purposes to provide the highest level of specificity,” Pritchett adds.

For the full list of added, revised, and deleted ICD-10 codes for 2022, go to www.cdc.gov/nchs/icd/icd10cm.htm, click on the ICD-10-CM FY 2022 Addenda PDF 2022 link, and download the Table and Index zip file.