Pathology/Lab Coding Alert

If you stick with generic neuroendocrine cancer codes, your claims will lack ICD-9's specificity requirement. Avoid this error and more by making the following changes, effective Oct. 1.

Most of the ICD-9 2010 changes expand disease subcategories to provide more specific descriptions. Getting new diagnosis codes that provide additional specificity can certainly be a plus for coding accuracy, says Marvel J. Hammer, RN, CPC, CCSP, PCS, ACS-PM, CHCO, of MJH Consulting in Denver.

Change 1: Merkel Cell CA: Switch 173.x for 209.3x

ICD-9 2010 introduces six new diagnosis codes that describe Merkel cell carcinoma, an aggressive neuroendocrine skin cancer that tends to grow quickly and may metastasize at an early stage. You didn't have a specific code for Merkel cell before now.

Physicians diagnose approximately 1,500 new cases of Merkel cell carcinoma each year. That number is on the rise, and the new codes should help identify and track patients, according to the ICD-9-CM Coordination and Maintenance Committee September 2008 agenda.

2009 way: You currently report 173.x (Other malignant neoplasm of skin) for Merkel cell carcinoma.

2010 method: You'll have specific codes for Merkel cell carcinoma, and you'll be able to specify the site. ICD-9 2010's more specific options include:

• 209.31 -- Merkel cell carcinoma of the face

• 209.32 -- ... of the scalp and neck

• 209.33 -- ... of the upper limb

• 209.34 -- ... of the lower limb

• 209.35 -- ... of the trunk

• 209.36 -- ... of other sites .

What happens if you don't know the Merkel cell carcinoma's site? The ICD-9 committee stated that 209.30 (Malignant poorly differentiated neuroendocrine carcinoma, any site) is not appropriate for Merkel cell carcinoma of unknown site. If the primary site is unknown, you will have to take your coding hunt to 209.75 (Merkel cell carcinoma, unknown primary site), according to the IPPS proposed rule.

Code 209.75 sits near the end of a new list of secondary neuroendocrine tumor codes:

• 209.70 -- Secondary neuroendocrine tumor, unspecified site

• 209.71 -- ... of distant lymph nodes

• 209.72 -- ... of liver

• 209.73 -- ... of bone

• 209.74 -- ... of peritoneum

• 209.75 -- Merkel cell carcinoma, unknown primary site

• 209.79 -- Secondary neuroendocrine tumor of other sites.

This new secondary neuroendocrine tumor category (209) is connected to a new personal history code for neuroendocrine tumors. ICD-9 2010 will revise V10.9 (Unspecified personal history of malignant neoplasm) to include two four-digit codes:

• V10.90 -- Personal history of unspecified type of malignant neoplasm

• V10.91 -- Personal history of malignant neuroendocrine tumor.

Be sure you remember to trade 239.8 for 239.89. ICD-9 2010 will delete 239.8 (Neoplasms of unspecified nature; other specified sites) and require a fourth digit for codes in this category:

• 239.81 -- Neoplasms of unspecified nature, retina and choroid

• 239.89 -- ... other specified sites.

Reason: New York ophthalmologist Bruce Hyman, MD, requested a unique code to identify suspicious areas in the retina that require observation over time. The location makes biopsy difficult, so physicians typically take a watch-and-see approach until the spot grows.

Tip: You don't need histologic confirmation to report these "unspecified nature" codes, according to the ICD-9 March 2008 committee meeting minutes.

Get ready to use two new, more specific codes for endometrial hyperplasia. ICD-9 2010 adds the following codes:

• 621.34 -- Benign endometrial hyperplasia

• 621.35 -- Endometrial intraepithelial neoplasia (EIN).

"ICD-9 introduced these new codes because pathologists increasingly use a disease classification that distinguishes the benign hormonal effects of unopposed estrogens (benign hyperplasia) from emergent  recancerous lesions (endometrial intraepithelial neoplasia [EIN])," explains Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M.

"But because some pathologists still use the older, four-tier hyperplasia statements, the existing codes remain," Witt continues.

2009 way: If you're coding EIN or benign hyperplasia prior to Oct. 1, Witt says your code choices are:

• For EIN -- use either 233.2 (Carcinoma in situ of other and unspecified parts of uterus) or 621.33 (Endometrial hyperplasia with atypia)

• For benign hyperplasia " use 621.30 (Endometrial hyperplasia, unspecified) or 621.31 (Simple endometrial hyperplasia without atypia).

Get the full picture: You'll find the Inpatient Prospective Payment System (IPPS) proposed rule containing 2010 ICD-9 code changes published in the May 22 Federal Register. To read the complete list of new, revised, and deleted ICD-9 codes that will take effect on Oct. 1, visit http://edocket.access.gpo.gov/2009/pdf/E9-10458.pdf and scroll to page 409.