Pathology/Lab Coding Alert

Use 2017 codes as of October 1.

Ever since you started using ICD-10-CM for diagnosis coding in your lab, you haven’t had to deal with annual updates — until now.

As of Oct. 1, you should be using the first updated codes since the initial ICD-10 implementation. To make sure you’re on top of the changes, let’s look at a few revisions that might impact your pathology and laboratory reporting.

Look back: We’ve covered some of the lab changes in “Jump On Diagnosis Changes Coming This October” in Pathology/Lab Coding Alert vol. 17 no. 7.

Remember: “Payment can be affected if payers update their policies reflecting the code changes and your practice does not. Make sure you are prepared,” advises Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Find it here: The National Center for Health Statistics (NCHS) has published diagnosis code updates at www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. The site provides downloadable PDF files of the code set, and a 2017 ICD-10-CM Conversion Table that provides a crosswalk between 2016 and 2017 codes.

Implement These Cancer Changes

ICD-10 provides site-specific codes for malignant carcinoid tumors, and ICD-10 2017 updates a few of the codes by changing the code definitions from “NOS,” which means “not otherwise specified,” to “unspecified,” as follows:

• C7A.094 — Malignant carcinoid tumor of the foregut, unspecified
• C7A.095 — Malignant carcinoid tumor of the midgut, unspecified
• C7A.096 — Malignant carcinoid tumor of the hindgut, unspecified.

Even without specific documentation regarding the site of the tumor, these revised diagnosis codes “will allow providers to choose a diagnosis that matches their documentation,” says Janae Ballard, CPC, COC, CPMA, CEMC, Manager, Professional Audit Services, Altegra Health, Los Angeles, CA.

ICD-10-CM 2017 also revises descriptors for the fifty-plus codes related to Hodgkin’s lymphoma, by dropping the word “classical” from the definitions. For instance, you’ll revise findings from intra-abdominal lymph nodes from C81.13 (Nodular sclerosis classical Hodgkin lymphoma, intra-abdominal lymph nodes) to (Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes).

Simplify Viral Hepatitis Coding

The 2017 ICD-10-CM update deletes diagnosis codes for viral hepatitis carrier status, and consolidates that condition into the codes for chronic viral hepatitis. The following table demonstrates the changes that will impact how your lab reports these diagnoses:

Don’t Miss Prostate Dx Changes

ICD-10-CM 2017 adds specificity for 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.

“The expansion would aid in tracking the types of dysplasia of the prostate allowing more specific tracking of types/cause/severity/progression and evolving treatment guideline limitations,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting.

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