Pathology/Lab Coding Alert

Apply the same BRCA positive rules when the codes change.

You won't see "BRCA" in any code definition for ICD-9 or ICD-10, but you will see a one-to-one correspondence in the code sets for reporting this and other genetic mutations that lead to neoplasm susceptibility.

Don't miss: The ICD-10 implementation deadline is shifting from Oct. 1, 2013. Read more about it in "Delay Gives You More Time to Implement ICD-10, HHS Confirms "on page xxx in this issue.

Compare ICD-9, ICD-10 Genetic Susceptibility

Certain mutations in the BRCA-1 and BRCA-2 genes can lead to increased breast and ovarian cancer risk in women. Here's how the two code set options compare for BRCA positive results:

ICD-9: Under ICD-9, you should use one of the following codes:

• V84.01 -- Genetic susceptibility to malignant neoplasm of breast
• V84.02 -- Genetic susceptibility to malignant neoplasm of ovary

ICD-10: Your ICD-10 options offer up familiar terms:

• Z15.01 -- Genetic susceptibility to malignant neoplasm of breast
• Z15.02 -- Genetic susceptibility to malignant neoplasm of ovary

Procedure leads choice: Neither ICD-9 nor ICD-10 distinguishes the codes based on whether the confirmed genetic test is BRCA-1 and/or BRCA-2 positive. Rather, you choose the code depending on the medical procedure.

For instance: The pathologist examines a prophylactic oophorectomy specimen (such as 88305, Level IV - Surgical pathology, gross and microscopic examination, ovary with or without tube, non-neoplastic) for a patient with confirmed BRCA-2 positive test results. The appropriate diagnosis coding would be V50.42 (Prophylactic ovary removal) with secondary diagnosis V84.02.

ICD-10 crosswalk: Once ICD-10 is in effect, you'll report the prophylactic oophorectomy as Z40.02 (Encounter for prophylactic removal of ovary).

Remember: When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.