Pathology/Lab Coding Alert

In with the new, but not out with the old -- that's how you'll have to use 2010 ICD-9 changes to interpret your endometrium pathology reports.

"Although many pathologists have moved to a two-level endometrial classification that distinguishes benign estrogen-induced changes from emergent pre-cancerous lesions, some pathologists persist with the older, four-tier descriptive hyperplasia classification," says Melanie Witt, RN, CPC, COBGC, MA, a coding expert based in Guadalupita, N.M.

That's why ICD-9 2010 adds two new codes -- and keeps four old codes -- under 621.3 (Endometrial hyperplasia).

Use the following guidelines to help you get your 621.3x coding right -- every time.

Since 2005, coders have had the following four codes to describe endometrial hyperplasia:

• 621.30 -- Endometrial hyperplasia, unspecified

• 621.31 -- Simple endometrial hyperplasia without atypia

• 621.32 -- Complex endometrial hyperplasia without atypia

• 621.33 -- Endometrial hyperplasia with atypia.

These codes align fairly well with the four-class World Health Organization (WHO) diagnostic system for endometrial hyperplasia that subdivides the findings according to architectural complexity (simple versus complex) and the presence of cytologic atypia. Pathologists might also use related descriptors for the hyperplasia, such as "mild," "severe," and "atypical."

Although most pathologists now adhere to a newer, two-tier classification system that prompted the new ICD-9 codes, these older codes remain in place.

Do this: "When you code a pathology report that describes endometrial hyperplasia using descriptors such as 'simple,' 'complex,' 'atypical,' or other terms such as 'cystic' or 'glandular,' select the proper code from 621.30-621.33," Witt advises.

Pay special attention to the ICD-9 text notes, which will help you select the proper code. For instance, ICD-9 2010 lists the following descriptors under 621.30:

• Hyperplasia (adenomatous) (cystic) (glandular) of endometrium

• Hyperplastic endometritis.

That means you should use the "unspecified" endometrial hyperplasia code (621.30) if you see any of these terms.

Tip: "Watch the 'excludes' notes under 621.31-621.33, and they'll direct you to use the new ICD-9 codes when appropriate," Witt says.

When you code a pathology report that uses the newer classification for endometrial hyperplasia, get ready to use two new ICD-9 2010 codes as follows:

• 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 precancerous lesions (endometrial intraepithelial neoplasia [EIN])," Witt explains.

Do this: If the endometrium pathology report uses the terms "benign hyperplasia" or "EIN," assign either 621.34 or 621.35, respectively. To ensure that you don't use older codes when your pathologist uses the newer terminology, an ICD-9 text note under 621.31 and 621.32 states "excludes benign endometrial hyperplasia" and directs you to 621.34. Similarly, a note under 621.33 states "excludes endometrial intraepithelial neoplasia (EIN)" and directs you to 621.35.

Old way: If your pathologist has been using the "benign hyperplasia" and "EIN" distinction prior to ICD-9 2010, you've probably been coding as follows:

• For EIN you may have used either 233.2 (Carcinoma in situ of other and unspecified parts of uterus) or 621.33. Remember to change this to 621.35.

• For benign hyperplasia you might have used 621.30 or 621.31. Remember to change this to 621.34.

When will you use assign a code from the range 621.30 to 621.35? When your pathologist diagnoses an endometrial tissue specimen from a surgical procedure such as colposcopy or hysterectomy.

You should be familiar with the following CPT codes, as well as a wide range of specimen terminology that you might see in endometrial pathology reports:

• 88305 -- Level IV -- Surgical pathology, gross and microscopic examination, endometrium, curettings/biopsy

• 88307 -- Level V -- Surgical pathology, gross and microscopic examination, uterus, with or without tubes and ovaries, other than neoplastic/prolapse.

Roadblock: You might see other terms in the pathology report that could describe specimens with endometrial hyperplasia. You'll have to recognize these terms if you want to report the correct procedure and diagnosis codes. Some of the terminology you might see in your pathologist's documentation includes:

• EMC -- This is a common abbreviation for endometrial curettings. "When you see the specimen described as EMC, you should report the procedure as 88305," says Tina Burkhalter, billing manager with SouthEastern Pathology in Rome, Ga.

• Myometrium -- Tissue labeled myometrium is typically a biopsy containing some mucosal uterine lining (endometrium) and some underlying uterine muscle (myometrium). You should list this specimen as 88305.

• Hysterectomy -- A hysterectomy specimen is the surgically removed uterus. For non-prolapse, nonneoplastic diagnoses, use 88307.