Oncology & Hematology Coding Alert

ICD-9 2009 brings a truckload of new leukemia codes to help with your constant quest for the highest degree of specificity.

The big changes come from a slew of new codes for conditions involving leukemia relapse. Let our experts show you what you need to know.

The lowdown: CMS just released its preliminary 2009 ICD-9 list. The changes aren't official yet, but this analysis will give you a head start on the changes that will most likely go into effect Oct. 1.

ICD-9 now offers the following fifth-digit options for leukemia codes in the 203-208 range:

- 0 -- without mention of remission

- 1 -- in remission.

As of now, you have no specific fifth-digit option to indicate relapse. Using 2008 ICD-9 options, you use the fifth digit of "0" and check patient charts for physician notes indicating relapse, says Kelly Reibman, CPC, a biller with oncologist Mariette Austin, PhD, MD, in Bethlehem, Pa.

Example: You should code for a patient diagnosed with chronic monocytic leukemia who had a relapse with 206.10 (Monocytic leukemia; chronic; without mention of remission).

According to the preliminary ICD-9 2009 codes CMS released, leukemia codes will include a new option for the fifth digit as of Oct. 1.

Leukemia codes with the new fifth-digit "2" will tell the payer that a patient has had a relapse for the condition you indicate with the ICD-9 code. The fifth digit will be available for 203.02-208.92. Here's an example of your new coding options for lymphoid leukemia:

- 204.02 -- Acute lymphoid leukemia; in relapse

- 204.12 -- Chronic lymphoid leukemia; in relapse

- 204.22 -- Subacute lymphoid leukemia; in relapse

- 204.82 -- Other lymphoid leukemia; in relapse

- 204.92 -- Unspecified lymphoid leukemia; in relapse.

Benefit: With the addition of this new fifth digit, you can code to the highest specificity without worrying that your coding isn't expressing every aspect of the oncologist's diagnosis.

These new codes will assist you by letting the insurance carriers know that patients have relapsed and that they may need additional treatment or testing, Reibman says.

More specific codes can be helpful especially when payer policies require them, says Lonna Maile, coding manager with Hawaii Pacific Health.

The challenge lies in educating your physician on the necessity for accurately documenting diagnoses to the highest specificity, Maile says.

What to do: Be sure the oncologist understands the importance of documenting the relapse in the patient's chart, Reibman says. Without that documentation, you may end up not choosing the most accurate code, she says.

Tip: "Oncology coders have to keep up-to-date with all the changes and have their practice management systems updated with the codes," Reibman says. You should also be sure to update the superbill/encounter form you use to capture the codes from the doctor and other personnel, she says.

And once the codes become official, you may decide to give your oncologist a list of the new codes so that he-ll know what information you need to choose the most specific code.

Stay tuned: Be sure to check back next month for coverage of more of the new ICD-9 codes.

More info: You can e-mail joec@eliresearch.com for a PDF copy of CMS- preliminary ICD-9 list.