Primary Care Coding Alert

ICD-9 2012:

Fifth Digits Add Specificity to 173.x Skin Cancer Codes

Check these new options to help physicians pinpoint the type of diagnosis.

When the updated version of ICD-9-CM goes into effect October 1, you'll have a few new options for reporting skin cancers in various locations.

"Statistics show that skin cancer is a growing problem, and family physicians may often be the first point of contact for diagnosing skin cancers," says Kent J. Moore, manager of healthcare delivery and financing systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. "This diagnosis coding change is very relevant to family physicians."

The extensions occur in code family 173.xx (Other malignant neoplasm of skin):

  • 173.0x -- Other malignant neoplasm of skin of lip
  • 173.1x -- Other malignant neoplasm of skin of eyelid including canthus
  • 173.2x -- Other malignant neoplasm of skin of ear and external auditory canal
  • 173.3x -- Other malignant neoplasm of skin of other and unspecified parts of face
  • 173.4x -- Other malignant neoplasm of scalp and skin of neck
  • 173.5x -- Other malignant neoplasm of skin of trunk except scrotum
  • 173.6x -- Other malignant neoplasm of skin of upper limb including shoulder
  • 173.7x -- Other malignant neoplasm of skin of lower limb including hip
  • 173.8x -- Other malignant neoplasm of other specified sites of skin
  • 173.9x -- Other malignant neoplasm of skin site, unspecified.

The new fifth-digit options give more details regarding the type of neoplasm or carcinoma the physician diagnoses. The structure is consistent for each code, which makes your selection easier. Your new options for the fifth digit are:

  • 0 -- Unspecified malignant neoplasm
  • 1 -- Basal cell carcinoma
  • 2 -- Squamous cell carcinoma
  • 9 -- Other specified malignant neoplasm.

Caution: The expansion means the four-digit 173.x codes will become invalid in October because each code in the range will require a fifth digit to be complete.

"Preparing for the new and revised ICD-9 code changes requires creating better documentation habits," says Kelly C. Loya, CHC, CPC-I, CPhT, managing consultant with Sinaiko Healthcare Consulting Inc. "Encourage physicians to document the type, specific location, and nature of the disease process when it is known."

Watch for: It's uncertain whether ICD-10 will include expanded skin neoplasm codes when the new system goes into effect in October 2013. Currently, ICD-10 is slated to include C44.0-C44.9 (Other malignant neoplasms of skin ...), a code series that does not have the same specificity as the proposed ICD-9 2012 codes.

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