Pathology/Lab Coding Alert

Keep up-to-date for future quality pay.

Allow our experts to unpack the latest ICD-10-CM changes to make sure you stay abreast of new diagnosis coding that will impact your lab.

Remember: Pathologists often assign diagnosis codes based on findings from procedures such as tissue exams, and clinical labs must use current ICD-10 codes assigned by the ordering physician to demonstrate medical necessity for ordered tests.

That’s not all: Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later.

“It is important to remain in compliance with ICD-10-CM coding and quality measures,” affirms Michele Midkiff, CPC-I, RCC, a coding consultant in Mountain View, CA.

With roughly 750 ICD-10-CM code additions, deletions, and revisions, let us help you focus on the most relevant changes for your lab:

Identify Mast Cell Disorders

If your pathologist diagnoses mastocytosis and mast cell neoplasms, you’ve got some ICD-10 changes coming down the pike. These disorders are due to abnormal proliferation or reactivity of mast cells, which are mediator cells of inflammatory response associated with vascular tissue throughout the body.

The World Health Organization (WHO) characterizes mast cell disorders as hyperplasia, or conditions ranging from benign skin aliments to malignant neoplastic infiltrating conditions. Mast cell disorders can impact various organs including gastrointestinal tract, liver, lymph, and bone marrow, or can cause a systemic condition known as a myeloproliferative neoplasm.

To accommodate the WHO classification, ICD-10 makes the following changes

• Revise C96.2, Malignant mast cell neoplasm, and add

                 o C96.20, Malignant mast cell neoplasm, unspecified
                 o C96.21, Aggressive systemic mastocytosis|
                 o C96.22, Mast cell sarcoma
                 o C96.29, Other malignant mast cell neoplasm

• Revise D47.0, Mast cell neoplasms of uncertain behavior, and add

                 o D47.01, Cutaneous mastocytosis (including listed conditions such as urticarial pigmentosa)
                 o D47.02, Systemic mastocytosis (including listed conditions such as Isolated bone marrow mastocytosis, mastocytosis NOS)
                 o Add “code also” instructions for any associated hematological non-mast cell lineage disease such as acute myeloid leukemia

• Revise Q82.2 Congenital cutaneous mastocytosis, add conditions such as Congenital diffuse cutaneous mastocytosis, and distinguish Q82.2 from non-congenital codes
• Revise “Excludes” notes under D89.4 Mast cell activation syndrome and related disorders to align with changes listed above.

Add Details to Breast Lump, Extrauterine Pregnancy

When your pathologist examines breast tissue or products of conception (POC) specimens, you’ll need to have more info on the anatomic site if you want to assign the correct ICD-10 beginning Oct. 1.

For instance, the latest update to the code set adds new codes with fourth and fifth-digit specificity based on laterality and breast quadrant, as follows:

• N63.0, Unspecified lump in unspecified breast
• N63.10, Unspecified lump in the right breast, unspecified quadrant
• N63.11, Unspecified lump in the right breast, upper outer quadrant
• N63.12, Unspecified lump in the right breast, upper inner quadrant
• N63.13, Unspecified lump in the right breast, lower outer quadrant
• N63.14, Unspecified lump in the right breast, lower inner quadrant
• N63.20, Unspecified lump in the left breast, unspecified quadrant and so on through N63.24 following the same pattern as N63.1
• N63.31, Unspecified lump in axillary tail of the right breast
• N63.32, Unspecified lump in axillary tail of the left breast
• N63.41, Unspecified lump in right breast, subareolar
• N63.42, Unspecified lump in left breast, subareolar.

The index also revises the entry for Breast Nodule to “Breast Nodule (see also Lump, breast) N63.0.”

Stipulate site of extrauterine pregnancy: ICD-10 2018 adds sixth-digit specificity to help you zero in on the anatomic site of POC taken from an organ other than the uterus by adding the following codes:

• O00.101, Right tubal pregnancy without intrauterine pregnancy
• O00.102, Left tubal pregnancy without intrauterine pregnancy
• O00.109, Unspecified tubal pregnancy without intrauterine pregnancy
• O00.111, Right tubal pregnancy with intrauterine pregnancy - follow same sixth-digit pattern for left (2) and unspecified (9)
• O0.201, Right ovarian pregnancy without intrauterine pregnancy - - follow same sixth-digit pattern for left (2) and unspecified (9)
• O00.211, Right ovarian pregnancy with intrauterine pregnancy - - follow same sixth-digit pattern for left (2) and unspecified (9).

Update Antenatal Screening Codes

Clinical labs may perform testing during pregnancy that the physician orders to screen for certain fetal conditions. You’d typically use Z36 (Encounter for antenatal screening of mother) as the ordering diagnosis. But ICD-10 2018 expands Z36, so you’ll need to be ready to use the more specific codes that you might encounter for clinical lab tests, such as the following:

• Z36.5, Encounter for antenatal screening for isoimmunization
• Z36.84, Encounter for antenatal screening for fetal lung maturity
• Z36.85, Encounter for antenatal screening for Streptococcus B
• Z36.89, Encounter for other specified antenatal screening
• Z36.8A, Encounter for antenatal screening for other genetic defects
• Z36.9, Encounter for antenatal screening, unspecified.

Note: there are more new codes in this section that wouldn’t apply to clinical labs, such as Z36.4 (Encounter for antenatal screening for fetal growth retardation) (small for dates).

Expand These Codes for Specificity

Here’s a sampling of some other new codes your lab might encounter that require extra digits for more specific reporting in ICD-10 2018:

A04.71, Enterocolitis due to Clostridium difficile, recurrent
A04.72, Enterocolitis due to Clostridium difficile, not specified as recurrent
E85.81, Light chain (AL) amyloidosis
E85.82, Wild-type transthyretin-related (ATTR) amyloidosis
E85.89, Other amyloidosis.

ICD-10 2018 also adds lots of new codes for more-specific reporting of alcohol and drug-related conditions. The new codes involve fifth and sixth digits to distinguish mild, moderate, or severe substance abuse or remission, with distinctions for early or sustained remission. Some of the codes also specify associated conditions such as mood disorder. Although clinical labs won’t assign these codes, you can expect to see them as the specific ordering diagnosis for drug testing.

There’s More

We could only touch the highlights in this introduction to ICD-10-2018 — there are other changes that might impact your lab. But many of the revisions are merely “editorial changes (some to correct typos), and not new codes or anything that actually changes how you reportthe codes,” explains Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

Stay tuned to Pathology/Lab Coding Alert for more ICD-10 2018 updates and impacts. Plus, you can access the file yourself at https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.

You should use these codes October 1, 2017 through September 30, 2018. To help with the transition, General Equivalence Mappings (GEMs) will be available sometime in August 2017.

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