Oncology & Hematology Coding Alert
Know These 2025 ICD-10-CM Oncology Changes
And know why the changes are going to matter for Medicare billing. On Oct. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will add and/ or expand over 250 new ICD-10-CM diagnosis codes, affecting almost every chapter. Of concern to medical oncology are 64 additions and 14 revisions to codes in Chapters 2 and 3, and 13 additions and one revision to codes in Chapter 21. In this article, we will delve into the upcoming changes, and touch on how the Medicare Advantage model (version 28) will be affected. Take Note of These Hodgkin and Follicular Lymphoma in Remission Additions ICD-10-CM 2025 has expanded C81.- (Hodgkin lymphoma) to include codes for each subcategory in the group that indicate the patient’s condition is in remission. The new codes follow the same first four characters as the existing Hodgkin lymphoma condition subcategories but add a 5th character, “A,” to describe the patient’s remission status. So, you will now code a patient in remission for lymphocyte-depleted Hodgkin lymphoma with C81.3A, while you’ll code a patient with lymphocyte-rich Hodgkin lymphoma that is now in remission with C81.4A. ICD-10-CM 2025 made the same revision to the C82.- (Follicular lymphoma) codes. For example, a patient in remission for grade IIIa follicular lymphoma will be coded to C82.3A, while you will use C82.5A for a patient in remission for diffuse follicle center lymphoma. Check Out These New Remission Status Codes for Other Lymphomas ICD-10-CM 2025 has also expanded the other lymphoma code groups to include “in remission” codes for all the code subcategories. Examples include: Significantly, the 2025 ICD-10-CM code set also expands the C86.- (Other specified types of T/NK-cell lymphoma) and C88.- (Malignant immunoproliferative diseases and certain other B-cell lymphomas) categories not only with “in remission” codes, this time indicated with 5th character 1, but also with “not having achieved remission” codes, indicated with 5th character 0. Examples here include such codes as: Don’t Miss These New Condition Codes To add extra specificity to C83.39 (Diffuse large B-cell lymphoma, extranodal and solid organ sites), ICD-10-CM 2025 has also added two new codes: Don’t forget to take note of the Excludes1 instruction for C83.390, which lists several other lymphoma codes which you must not code with this condition. Stay Alert to This Major Estrogen Receptor Status Code Overhaul Finally, ICD-10-CM 2025 has radically revised the Z17.- (Estrogen receptor status) category, including the Z17.- category code descriptor which will state Estrogen, and other hormones and factors receptor status. Beginning Oct. 1, 2024, you’ll have the following eight codes to accompany Z17.0 (Estrogen receptor positive status [ER+]) and Z17.1 (Estrogen receptor negative status [ER-]): Be aware of the instructions added under Z17.- and Z17.4- that tell you to use one code, as available, for each receptor coded to Z17.0, Z17.1, Z17.2-, and Z17.3-, and to code first any malignant neoplasm, such as C56.- (Malignant neoplasm of ovary). Understand the Significance of the Change All these additions and expansions emphasize the importance of sufficient detail within documentation, so you can report the highest level of specificity and severity for these conditions. CMS is also preparing oncology coding for release of the full version 28 model final rule for the CY 2025 reporting period. Clinical documentation improvement will take a front seat and be even more important to support the highest specificity available to report a patient’s condition and risk. The adjustments from version 24 to version 28 have already seen a significant decrease in risk adjustment factors with the removal of acute conditions that can be managed by medication and/or are unspecified. Watch for a future article on how these changes will affect risk adjustment scores. Amy Pritchett, AAPC Fellow, RAP, CRC, CPA-RA, CCS, CPC, CPMA, CPCO, CDEI. CDEO, CANPC, CASCC, CMPM, Senior Manager, HCC Coding, Audit & Education Services at Pinnacle Enterprise Risk Consulting Services LLC in Mobile, Alabama
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