Pathology/Lab Coding Alert

Add cervical site for ICD-10 diagnosis.

When your pathologist diagnoses cervical carcinoma in situ, you'll need to make sure to get the lesion location from the op report if you want to use the most specific ICD-10 diagnosis starting in 2013.

That's because when ICD-9 becomes ICD-10 in 2013, you will not always have a simple one-to-one relationship between old codes and the new ones -- and that's the case for reporting severe cervical dysplasia.

ICD-10 difference: Instead of relying on one code, 233.1 (Carcinoma in situ, cervix uteri), you'll have multiple ICD-10 options under D06 (Carcinoma in situ of cervix uteri) as follows:

• D06.0 -- Carcinoma in situ of endocervix
• D06.1 -- Carcinoma in situ of exocervix
• D06.7 -- Carcinoma in situ of other parts of cervix
• D06.9 -- Carcinoma in situ of cervix, unspecified.

Physician documentation: The key difference between 233.1 and the D06 category is the specific location of the lesion " endocervix, exocervix, "other parts," or unspecified. That's why pathologists will need to move the lesion location information forward in the pathology report if specified by the surgeon's op note.

That's not all: Location isn't the only difference in ICD-9 and ICD-10. How you code "severe dysplasia" will also change, as follows:

• D06: Includes cervical intraepithelial neoplasia [CIN], grade III, with or without mention of severe dysplasia Excludes severe dysplasia of cervix NOS (N87.2)
• 233.1: Includes CIN III Includes severe dysplasia of cervix

Watch the change: That means if the pathology report states "severe dysplasia of cervix" without mention of CIN III, you'd list 233.1 under ICD-9, but N87.2 (Severe cervical dysplasia, not elsewhere classified) under ICD-10.