Pulmonology Coding Alert

At last, coders may finally have a place to turn for secondary mesothelioma and other conditions.

Mesothelioma coding could be set for a pretty big overhaul as part of the Oct. 1, 2017, ICD-10 update. That’s the word from the changes proposed at the ICD-10 Coordination and Maintenance Committee meeting in March.

The Committee will not make final decisions until later this year, but the following proposals are on the table and could impact pulmonology practices nationwide if they’re approved.

Focus on Category Expansion

The proposal includes potential additions that would provide new codes and categories for mesothelioma, a condition that affects the lining of the lungs. The changes were requested by the Alliance of Dedicated Cancer Centers and presented by David Berglund, MD at the March meeting. “ICD-10-CM has specific codes for mesothelioma,” the meeting said presentation. “However, there are no specific codes for secondary mesothelioma, for personal history of mesothelioma, or mesothelioma in remission.”

It’s possible that this could all change in October, if the proposals are accepted as final updates. The first modification would involve a new code under the C45 (Mesothelioma) heading in ICD-10. The new code would be C45.A (Mesothelioma, in remission) for patients who respond to treatment and see their condition go into remission.

More significantly, the ICD-10 committee is considering an entire new category, C7C, which would describe “Secondary mesothelioma.” You would select the appropriate fourth character depending on the site of the secondary mesothelioma from the following potential new code list:

• C7C.1 — Secondary mesothelioma of distant lymph nodes
• C7C.2 — Secondary mesothelioma of lung
• C7C.3 — Secondary mesothelioma of bone/Secondary mesothelioma of vertebrae
• C7C.4 — Secondary mesothelioma of thoracic wall
• C7C.5 — Secondary mesothelioma of liver
• C7C.8 — Secondary mesothelioma of other sites
• C7C.9 — Secondary mesothelioma, unspecified site

The new codes and category should help pulmonology practices better select an appropriate code. “The greater the specificity in the code, the easier it should be for the coder to assign (or not assign) that code,” advises Susan Stovall, COC, CPC, AAS, medical billing and coding instructor with the Southwest Skill Center in Avondale, Ariz. “Usually, difficulties arise when a code is not specific enough, opening the door to second guessing.”

These Codes May Prevent You From Using Z85 for Mesothelioma

In addition to the above codes, you’ll also find a new Excludes2 note under Z85 (Personal history of malignant neoplasm) barring you from using Z85 for mesothelioma in remission and for personal history of mesothelioma. You would instead report these conditions using new code C45.A if it is finalized by the committee.

The tabular index would also be updated so if you looked under “History,” then “Personal,” you would be directed to a new listing for “Mesothelioma,” which would direct you to C45.A.

Resource: These proposals were discussed at the ICD-10 Coordination and Maintenance Committee Meeting March 7-8, 2017. You can review the proposals at https://www.cdc.gov/nchs/data/icd/topic-packet_03_07_17.pdf.