Pathology/Lab Coding Alert

New codes show medical necessity, pathologist's diagnosis

From herpesvirus lab tests to non-Hodgkin's lymphoma diagnoses, you-ll need to know the fall ICD-9 code lineup if you want to get paid for your work.

Get ready now to avoid deleted codes and start using new codes to show medical necessity for lab tests. Pathologists need to prepare for changes too, so they can report the most accurate cancer diagnoses based on specimen exams.

ICD-9 Codes Show Medical Necessity

Even though your lab doesn't assign the diagnosis code for ordered tests, you must be familiar with how these codes show medical necessity.

According to Lori Hendrix, CPC, CPC-H, coding consultant with Coding Strategies Inc. in Powder Springs, Ga., the ordering physician must supply the diagnostic information that shows the reason for the test. And the physician's diagnosis should support that the test is -reasonable and necessary- to meet the patient's medical need.

For many lab tests, Medicare provides a National Coverage Determination (NCD) that specifies which ICD-9 codes support medical necessity. Medicare updates NCDs quarterly, incorporating ICD-9 code changes in the -covered diagnoses- lists. You-ll need to keep up with these changes to know when your lab should secure a signed advance beneficiary notification (ABN) if a physician orders a test without a payable diagnosis.

Pathologists Assign Final Diagnosis

Unlike clinical lab tests that you report with the ordering physician's diagnosis, you-ll often report a pathology exam using a definitive diagnosis that your pathologist makes.

ICD-9 coding instructions state that if a physician makes a confirmed diagnosis based on the results of the diagnostic test, you should report the confirmed diagnosis, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. That means you need to be abreast of current ICD-9 coding for neoplasms and other conditions your pathologist might diagnose.

For example: Your pathologist receives a surgical specimen identified as a -mole from the right forearm.- The pathologist personally reviews the specimen slides and makes a diagnosis of -malignant melanoma.- The pathologist should report 172.6 (Malignant melanoma of skin; upper limb, including shoulder) as the primary diagnosis, Miller says.
 
Get Ready for October Changes

Beginning this fall, many of the nearly 170 new and revised ICD-9 codes will impact coding for labs and pathologists. Get familiar with the following code changes so you-ll be ready to use them when the time comes. Remember, you no longer have a grace period for using these codes--you must implement them on Oct. 1 to get
paid for your services.

Lymphoma changes: ICD-9 overhauls non-Hodgkin's lymphoma coding by adding the following new codes:

- 200.4x--Mantle cell lymphoma

- 200.5x--Primary central nervous system lymphoma

- 200.6x--Anaplastic large cell lymphoma

- 200.7x--Large cell lymphoma

- 202.7x--Peripheral T cell lymphoma.

Don't miss: These codes require a fifth digit depending on the lymph node location, with 0 indicating unspecified site or extranodal and solid tumors, 8 indicating multiple sites, and 1-7 indicating sites from the head to the spleen.

Female genitalia carcinoma in situ: Beginning in October, you should no longer report 233.3 (Carcinoma in situ; other and unspecified female genital organs). Instead, you should report the new, more specific codes, as follows:

- 233.30--Carcinoma in situ, unspecified female genital organ

- 233.31--Carcinoma in situ, vagina

- 233.32--Carcinoma in situ, vulva

- 233.39--Carcinoma in situ, other female genital organ.

Vulvar dysplasia: In keeping with current coding for CIN (cervical intraepithelial neoplasia), ICD-9 is updating coding for VIN (vulvar intraepithelial neoplasia). Beginning in October, 624.0 (Dystrophy of vulva) becomes a subcategory that you should not report alone. Nor should you report VIN I and VIN II as 624.8 (Other specified noninflammatory disorders of vulva and perineum). Instead, you should report VIN using the new, more specific codes as follows:

- 624.01--Vulvar intraepithelial neoplasia I [VIN I]

- 624.02--Vulvar intraepithelial neoplasia II [VIN II]

- 624.09--Other dystrophy of vulva.

With these code changes, you should report vulvar kraurosis or leukoplakia as 624.09 rather than 624.0.

Learn MEN Changes, Too

Pathologists may diagnose various endocrine gland tumors that are part of a group of familial syndromes called multiple endocrine neoplasia (MEN). Now, you report MEN type I (Wermer's syndrome) as 258.0 (Polyglandular activity in multiple endocrine adenomatosis) and MEN type IIA (Sipple's syndrome) as 193 (Malignant neoplasm of thyroid gland). Because these disparate codes don't adequately describe complex MEN syndromes, ICD-9 is introducing three new codes in October to describe these diagnoses:

- 258.01--Multiple endocrine neoplasia (MEN) type I

- 258.02--Multiple endocrine neoplasia (MEN) type IIA

- 258.03--Multiple endocrine neoplasia (MEN) type IIB.

You will also have a new code for patients who have a genetic susceptibility to these conditions--V84.81 (Genetic susceptibility to multiple endocrine neoplasia [MEN]).

Herpesvirus changes: Because current ICD-9 codes don't distinguish between many separately identifiable and clinically significant herpesvirus strains, the October update will add the following new codes that might be important for your lab coding:

- 058.10--Roseola infantum, unspecified

- 058.11--Roseola infantum due to human herpesvirus 6

- 058.12--Roseola infantum due to human herpesvirus 7

- 058.21--Human herpesvirus 6 encephalitis

- 058.29--Other human herpesvirus encephalitis

- 058.81--Human herpesvirus 6 infection

- 058.82--Human herpesvirus 7 infection

- 058.89--Other human herpesvirus infection.

Use new V codes: Because physicians often order lab tests for screening or based on risk factors that may indicate medical necessity for a test, you need to be aware of the following new V codes. Look for direction in coverage policies and NCDs about how these codes might indicate the need for certain tests when the ordering physician indicates these factors:

- V13.22--Personal history of cervical dysplasia

- V16.52--Family history of malignant neoplasm, bladder

- V18.19--Family history of other endocrine and metabolic diseases

- V73.81--Special screening examination, Human papillomavirus (HPV)

- V84.81--Genetic susceptibility to multiple endocrine neoplasia (MEN)

- V84.89--Genetic susceptibility to other disease.