Oncology & Hematology Coding Alert

If you stop your search for a Kaposi's sarcoma ICD-9 code at 176.x (Kaposi's sarcoma), you're at risk of choosing the wrong principal diagnosis. Here's what you need to know.

When coding Kaposi's sarcoma, be sure you understand when you should report both the condition and its cause. Kaposi's sarcoma herpes virus (KSHV) causes Kaposi's sarcoma but typically only in patients with immune system issues. HIV infection is the most common culprit in the U.S.

ICD-9 official guidelines state, "If a patient is admitted for an HIV-related condition, the principal diagnosis should be 042, followed by additional diagnosis codes for all reported HIV-related conditions" (Section 1.C.1.a.2, www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm).

So if a patient presents for HIV-associated Kaposi's sarcoma treatment, the proper ICD-9 codes are 042 (Human immunodeficiency virus [HIV] disease) and then 176.x, says Denae Merrill, CPC, CEMC, president of Merrill Medical Management in Saginaw, Mich. Choose 176.x's fourth digit based on the sarcoma's location:

• 176.0 -- ... skin

• 176.1 -- ... soft tissue (ICD-9 notes that this includes blood vessel, connective tissue, fascia, ligament, lymphatic[s] NEC, muscle; but 176.1 excludes lymph glands and nodes [176.5])

• 176.2 -- ... palate

• 176.3 -- ... gastrointestinal sites

• 176.4 -- ... lung

• 176.5 -- ... lymph nodes

• 176.8 -- ... other specified sites (oral cavity NEC)

• 176.9 -- ... unspecified (viscera NOS).

Example: When a patient with HIV presents for treatment of Kaposi's sarcoma on the skin of his leg, you should report 042 followed by 176.0.

If you're confused about whether 042 is appropriate when the documentation states "AIDS," remember that 042 includes all the following terms, according to notes following the code:

• Acquired immune deficiency syndrome

• Acquired immunodeficiency syndrome

• AIDS

• AIDS-like syndrome

• AIDS-related complex

• ARC

• HIV infection, symptomatic.-

Don't miss: In addition to the requirement to report all HIV-related conditions, ICD-9 guidelines also instruct you to report an additional code -- 079.53 (Human immunodeficiency virus, type 2 [HIV-2]) -- if the patient is positive for HIV-2 infection. HIV-1 is more common in the U.S.