Pathology/Lab Coding Alert

Soon you-ll no longer choose a benign or malignant tumor diagnosis solely by site. Starting Oct. 1, you-ll need to use a new ICD-9 code for a carcinoid tumor to distinguish it from the biologically different adenocarcinoma or other benign tumors.

That's because ICD-9 2009 will include a new category 209.x (Neuroendocrine tumors), if the proposed codes become final in August.

For instance: You-ll no longer report a malignant carcinoid tumor of the jejunum as 152.1 (Malignant neoplasm of the small intestine; jejunum), but instead you-ll use 209.02 (Malignant carcinoid tumor of the jejunum).

New category 209 will contain 43 codes based on carcinoid tumors- location and behavior (benign or malignant).

Rationale: Neuroendocrine tumors occur most often in the bronchi, stomach, small intestine, appendix and rectum. Physicians classify these tumors according to the presumed origin, such as the "foregut" (bronchi and stomach), the "midgut" (small intestine and appendix), and the "hindgut" (colon and rectum).

These tumors produce amine and peptides that can cause characteristic hormonal syndromes, which means that these systemic syndromes (as well as the differences of locations) account for diverse clinical presentation, says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel.

Learn the codes: You can simplify the 43 codes if you become familiar with the subcategory (four-digit) ICD-9 groupings:

- 209.0x -- Malignant carcinoid tumor of the - [small intestine -- fifth digit specifies portion]

- 209.1x -- Malignant carcinoid tumor of the - [large intestine -- fifth digit specifies portion]

- 209.2x -- Malignant carcinoid tumor of - [other sites -- fifth digit specifies site such as lung, thymus, stomach, kidney, unknown, other]

- 209.30 -- Malignant poorly differentiated neuroendocrine carcinoma, any site

- 209.4x -- Benign carcinoid tumor of the - [small intestine -- fifth digit specifies portion]

- 209.5x -- Benign carcinoid tumor of the - [large intestine -- fifth digit specifies portion]

- 209.6x -- Benign carcinoid tumor of the - [other sites -- fifth digit specifies site such as lung, thymus, stomach, kidney, unknown, other].