Radiology Coding Alert

If you perform diagnostic or therapeutic services for cancer and other tumor patients, 2009 ICD-9 code changes are sure to keep you on your toes. Here's a look at what's coming down the pike.

Stay alert: The National Center for Health Statistics (NCHS) has not yet released the official addendum, which may offer other codes that will also go into effect Oct. 1.

But this sneak peek will help you prepare for what's to come.

ICD-9 2008 has the following fifth-digit options for leukemia codes in the 203.xx-208.xx range:

• 0 -- Without mention of remission

• 1 -- In remission.

Problem: These offer you no specific fifth-digit option to indicate relapse. Using 2008 ICD-9 options, you use the fifth digit of "0" and check patient charts for physician notes indicating relapse, says Kelly Reibman, CPC, a biller with Mariette Austin, PhD, MD, in Bethlehem, Pa.

Solution: A new fifth digit (2, In relapse) will be available for 203.xx-208.xx beginning Oct. 1.

Benefit: These new codes let the carriers know that patients have relapsed and that they may need additional treatment or testing, Reibman says.

The M.D. Anderson Cancer Center asked for a new category specifically identifying malignant and benign neuroendocrine tumors, and ICD-9 2009 will include carcinoid tumor code range 209.xx as a result.

These codes offer a more precise option and will provide more accurate statistics than the current 2008 options 157.4 (Malignant neoplasm of pancreas; Islets of Langerhans) and 259.2 (Other endocrine disorders; carcinoid syndrome), says James C. Yao, MD, associate professor with the University of Texas M.D. Anderson Cancer Center in his presentation on the new codes, "Neuroendocrine Tumors," at http://www.cdc.gov/nchs/ppt/icd9/att2_Yao_Sep07.ppt#683,8,NeuroendocrineTumors: CurrentSituation(1).

The appropriate malignant pleural effusion diagnosis code will soon be easier to find.

Your ICD-9 2008 option is 197.2 (Secondary malignant neoplasm of respiratory and digestive systems; pleura), says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. But in 2009 it will have its own code, 511.81 (Malignant pleural effusion).

You'll also have new code 199.2 (Malignant neoplasm associated with transplant organ) to increase your coding options for transplant patients.