Oncology & Hematology Coding Alert

Question: What is the correct way to code a mediastinal mass? When I look up mass in the ICD-10-CM Alphabetic Index, I am led to R22.2, which describes a mass of the chest or trunk. But the R22 codes are for the skin and subcutaneous (SQ) tissue, and mediastinal masses are deeper than that. My knowledge of anatomy and physiology (A&P) tells me it may be better to use J98.59. Is that a better choice?

AAPC Forum Participant

Answer: Yes, you should be able to report myelofibrosis alone on your claim using D75.81 (Myelofibrosis).

Here’s why: Myelofibrosis is a rare form of cancer that produces scarring of bone marrow tissue causing anemia and, in turn, fatigue and weakness. ICD-10-CM instructions for the code are extensive, telling you to code first the underlying disorder, such as malignant neoplasm of breast (C50.-), as well as use additional codes “if applicable” for associated therapy-related myelodysplastic syndrome and to identify any drug that may be causing an adverse effect.

Such instructions may lead you to think that the code cannot stand on its own. However, the inclusion terms for the condition provide the answer to your question, as they indicate the code can be used for both secondary myelofibrosis — the condition as a manifestation — and for myelofibrosis not otherwise specified, meaning you can also use the code when the condition is primary. This means you should be able to submit the claim without any other codes. Even so, it is also possible that a payer may reject the code, so you might want to query your provider further to see if there are any other codes you can list either as primary or additional.