Pathology/Lab Coding Alert

The annual update process is back in full swing.

You’ve had a five-year code freeze to ease transitioning to ICD-10 CM, but now you should get your lab ready to see the first set of annual updates this Oct. 1. The Centers for Disease Control and Prevention (CDC) has posted a preliminary list of ICD-10-CM changes for what will become ICD-10-CM 2017.

With the release of 1,943 new codes, 422 revisions, and 305 deletions for ICD-10-CM, “Change seems to be the name of the game,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA.

More detail: “The release of the new … ICD-10 CM codes will … enhance the specificity of patient stories captured in their health records,” said Lynne Thomas Gordon, CEO of American Health Information Management Association (AHIMA) in a statement regarding the update.

Be warned: The list is not yet final. The CDC will post the final addendum in June. But for now, read on to learn about some possible changes that could affect your pathology and laboratory coding.

Find New Codes for GIST

Currently, if your pathologist diagnoses a gastrointestinal stromal tumor (GIST), you have to choose a non-specific ICD-10 code for a malignant or “uncertain behavior” tumor by site, such as C17.- (Malignant neoplasm of small intestine…) or D37.2 (Neoplasm of uncertain behavior of small intestine) The ICD-10 update changes that by adding the following specific GIST codes:

• C49.A0 — Gastrointestinal stromal tumor, unspecified site
• C49.A1 — Gastrointestinal stromal tumor of esophagus
• C49.A2 — Gastrointestinal stromal tumor of stomach
• C49.A3 — Gastrointestinal stromal tumor of small intestine
• C49.A4 — Gastrointestinal stromal tumor of large intestine
• C49.A5 — Gastrointestinal stromal tumor of rectum
• C49.A9 — Gastrointestinal stromal tumor of other sites

Anticipate Prostate Changes

ICD-10 2017 changes the wording for enlarged prostate in a way that makes ICD-10 similar to how you reported the condition under ICD-9. For instance, N40.0 and N40.1 change from “enlarged prostate” to “benign prostatic hyperplasia” with or without lower urinary tract symptoms (luts).

The Oct. 1 revisions also add specificity for reporting prostate dysplasia by deleting N42.3 (Dysplasia of prostate) and replacing it with the following more specific codes:

• N42.30 — Unspecified dysplasia of prostate
• N42.31 — Prostatic intraepithelial neoplasia
• N42.32 — Atypical small acinar proliferation of prostate
• N42.39 — Other dysplasia of prostate.

Update Ovarian Cyst Coding

When your pathologist diagnoses an ovarian cyst, you’ll have some new code options once the ICD-10 update goes into effect. Make sure you’re ready to stop using the following codes:

• N83.0 — Follicular cyst of ovary
• N83.1 — Corpus luteum cyst
• N83.20 — Unspecified ovarian cysts
• N83.29 — Other ovarian cysts

In place of each of these codes, ICD-10 2017 requires you to use a more specific code that includes an additional (fifth or sixth) digit to indicate laterality of the ovarian cyst, as follows:

• 0 — unspecified side
• 1 — right ovary or right side
• 2 — left ovary or left side

Do this: To code as accurately as possible, pathologists should get information from the surgeon regarding whether the cystic ovary is from the right or left side.  

Look for Addenda Already

Even before the 2017 code set is finalized, the ICD-10 Coordination and Maintenance Committee reviewed additional proposals for addenda for FY 2018 to go into effect Oct. 1, 2017. Some of these changes could impact lab coding, such as the following:

The committee considered a proposal to expand A04.7 (Enterocolitis due to Clostridium difficile) to differentiate recurrent C diff enterocolitis from enterocolitis not specified as recurrent.

The committee also discussed adding a code for Zika virus. Currently, you report the condition with a non-specific code such as A92.8 (Other specified mosquito-borne viral fevers). The new code under consideration for the ICD-10-CM 2017 addenda is A92.5 (Zika virus disease).

Bottom line: Always report diagnoses to the highest level of specificity. With newly emerging infections such as Zika virus, rely on existing ICD-10-CM codes until the new, more specific codes become available, says Sarah Todt, RN, CPMA, CPC, CEDC, director of provider education and audit for LogixHealth, a national coding and billing company in, Bedford, MA.

Resource: To review the complete list, visit ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2017/NewICD10CMCodes_FY2017.txt.