Radiology Coding Alert

78811-78816 descriptor revisions could lead to increased coverage Your ICD-9 lymphoma options have already changed, and CPT has PET scan code changes in store for 2008. Here's what you need to know when you report your next lymphoma PET scan. ICD-9: Break the 202.80 Habit or Face Denials In 2007, you probably turned to 202.80 (Other lymphomas; unspecified site, extranodal and solid organ sites) for many of your lymphoma claims, but you have multiple new options as of Oct. 1: • marginal zone lymphoma (200.30-200.38)
• mantle cell lymphoma (200.40-200.48)
• primary central nervous system lymphoma (200.50-200.58)
• anaplastic large cell lymphoma (200.60-200.68)
• large cell lymphoma (200.70-200.78)
• peripheral T-cell lymphoma (202.70-202.78). Reporting unspecified code 202.80 less often is a benefit, but all of these new lymphoma codes may cause some problems of their own, says Erin Goodwin, CPC, CMC, reimbursement and coding professional with a South Carolina clinic. - What to watch for: Documentation must offer the details you need to choose among these new codes. The trick is finding the middle ground between the physician not documenting enough information and making his documentation so specific that you have a hard time choosing the most appropriate diagnosis code, Goodwin says. - What to do: Once you get the final list of new codes, give your providers a job aid with the more specific codes, Goodwin says. Your physicians may not know what information you need for each diagnosis, so you can show them the detail you need and point out that documenting those specifics helps you do your job more efficiently and helps satisfy payers when they ask for medical records, she says. - The provider's documentation should offer enough detail to allow you to choose among the following fifth-digit options: • 0 -- unspecified site, extranodal and solid organ sites
• 1 -- lymph nodes of head, face and neck
• 2 -- intrathoracic lymph nodes
• 3 -- intra-abdominal lymph nodes
• 4 -- lymph nodes of axilla and upper limb
• 5 -- lymph nodes of inguinal region and lower limb
• 6 -- intrapelvic lymph nodes
• 7 -- spleen
• 8 -- lymph nodes of multiple sites.- Stick to 78811-78816 Despite Descriptor Change PET and PET/CT codes 78811-78816 will no longer include the phrase "tumor imaging" effective Jan. 1, but you should still use these codes for lymphoma PET imaging. 2007 codes: Now you choose from the following CPT codes: • 78811 -- Tumor imaging, positron emission tomography (PET); limited area (e.g., chest, head/neck) • 78812 -- ... skull base to mid-thigh • 78813 -- ... whole body • 78814 -- Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (e.g., chest, head/neck) • [...]