Pathology/Lab Coding Alert

You'll shed the basal cell/squamous cell distinction in 2013.

You'll barely have time to get used to distinguishing "other" malignant skin neoplasms, such as basal cell and squamous cell carcinomas, using ICD-9 2012 changes when you'll drop the distinction again in ICD-10 -- effective Oct. 1, 2013.

Instead of distinguishing "other" skin cancer type with the fifth digit, ICD-10 codes will require a fifth digit for some skin sites based on a distinction between right, left, or unspecified.

40 Codes Shrink to 22

You just read in "173 and 041: Get Specific With Fifth Digits for Skin Cancer, E. coli" that ICD-9, 2012 creates 40 new 173.xx codes.

Based on the current proposed ICD-10 codes, you'll only have 22 codes to choose from in 2013, as you can see from the following list:

• C44.0 -- Malignant neoplasm of skin of lip
• C44.10 -- ... skin of unspecified eyelid, including canthus
• C44.11 -- ...skin of right eyelid, including canthus
• C44.12 -- ... skin of left eyelid, including canthus
• C44.20 -- ... skin of unspecified ear and external auricular canal
• C44.21 -- ... skin of right ear and external auricular canal
• C44.22 -- ...skin of left ear and external auricular canal
• C44.30 -- ... skin of unspecified part of face
• C44.31 -- ...skin of nose
• C44.32 -- ... skin of other parts of face
• C44.4 -- ... skin of scalp and neck
• C44.51 -- ... anal skin
• C44.52 -- ... skin of breast
• C44.59 -- ... other part of trunk
• C44.60 -- ... skin of unspecified upper limb, including shoulder
• C44.61 -- ... skin of right upper limb, including shoulder
• C44.62 -- ... skin of left upper limb, including shoulder
• C44.70 -- ... skin of unspecified lower limb, including hip
• C44.71 -- ... skin of right lower limb, including hip
• C44.72 -- ... skin of left lower limb, including hip
• C44.8 -- ... overlapping sites of skin
• C44.9 -- ... skin, unspecified.

Change focus: Starting Oct. 1, 2011 you'll need to be careful to extract information about other malignant skin cancer types (basal cell, squamous cell, unspecified, or other specified) from the pathology report for reporting to 173.xx. But beginning Oct. 1, 2013, you'll need to be careful to extract information from the pathology report about the skin site, including right or left, for C44.xx. Watch the pages of Pathology/Lab Coding Alert to see if that changes before ICD-10 implementation.

Clarify Codes for Cancer Registry

One reason for the expanded 173.xx codes is to help identify cancers reportable to central cancer registries.

"The vast majority of skin cancers are either basal or squamous cell, neither of which are reportable conditions to central cancer registries," according to the New York State Cancer Registry in a statement to the ICD-9-CM Coordination and Maintenance Committee Meeting. The expansion of the codes under category 173 in ICD-9 2012 allows facilities to distinguish reportable and non-reportable skin cancers, which may minimize the problem of facilities reporting all skin cancers to central registries.

Problem: Under currently proposed ICD-10 codes, you'll no longer be able to use diagnosis codes to distinguish certain skin cancers that aren't reportable to central cancer registries.