Radiology Coding Alert

A quick check of the index will keep you from reporting excluded diagnoses.

If you code for malignant ovarian neoplasms, your radiologist's documentation probably already includes the information needed for ICD-10's increased specificity requirements. You just need to be ready to capture it in your code choice.

ICD-9-CM Code

• 183.0, Malignant neoplasm of ovary

ICD-10-CM Codes

• C56.1, Malignant neoplasm of right ovary
• C56.2, ... left ovary
• C56.9, ... unspecified ovary.

The diagnosis: A malignant neoplasm of the ovary is a cancerous tumor. The diagnosis should be based on a confirmed pathology report.

ICD-9 coding rules: You currently have one code for a malignant ovarian neoplasm. ICD-9 guidelines for 183.0 instruct you to use an additional code to identify any functional activity, if known.

ICD-10 changes: As with many other bilateral organs, ICD-10 provides a way for you to distinguish which side -- right or left. If the medical record doesn't identify right or left, you'll have to use the "unspecified" ICD-10 code for the ovary. Like ICD-9, ICD-10 includes a note to "Use additional code to identify any functional activity."

Documentation: Physicians will need to ensure documentation of right or left ovary to take advantage of ICD-10's greater specificity. The radiologist should already be including this information as part of a thorough report, so for ICD-10 implementation, you just need to be sure you are able to capture the information quickly for coding.

Coder tips: The ICD-9 guidelines indicate that 183.0 is inappropriate for a neoplasm of Douglas' cul-de-sac (158.8, Malignant neoplasm of specified parts of peritoneum) or carcinoma in situ (233.39, Carcinoma in situ, other female genital organ). ICD-10 2013 doesn't include similar notes with C56.-, but that doesn't mean you should use this range for those diagnoses. Under ICD-10, a Douglas' cul-de-sac neoplasm is coded to C48.1 (Malignant neoplasm of specified parts of peritoneum). The appropriate code for a carcinoma in situ of the ovary is D07.39 (Carcinoma in situ of other female genital organs).

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014, as stated in the Sept. 5, 2012, Federal Register. The announcement ended months of speculation that began in April when CMS proposed delaying the original Oct. 1, 2013, implementation date. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.