Radiology Coding Alert

Abnormal imaging findings will lead you to an all new code range in ICD-10.

The Oct.1, 2013, implementation date for ICD-10-CM creeps ever closer, making preparation more important every day. Getting comfortable with the new code set requires a close look at those codes that don't have a precise one-to-one match with ICD-9-CM. The corresponding codes for 784.2 show precisely why paying attention to exclusion lists will be so important when the new codes become effective.

ICD-9-CM: Code 784.2 (Swelling mass or lump in head and neck) applies to the signs described in the definition and also has this inclusion list: "Space-occupying lesion, intracranial NOS."

ICD-10-CM: ICD-10-CM offers one code for a head-related diagnosis and another for the neck:

• R22.0, Localized swelling, mass and lump, head
• R22.1, Localized swelling, mass and lump, neck.

If you check general equivalence mappings (GEMs), you'll see that ICD-9 code 784.2 doesn't just cross to R22.0 and R22.1, however. Code 784.2 also crosses to ICD-10 code R90.0 (Intracranial space-occupying lesion found on diagnostic imaging of central nervous system).

Coder tips: Codes R22.0 and R22.1 have an exclusion list that's key for reminding you when you should turn to your third option, R90.0, instead (note the first bullet):

Abnormal findings on diagnostic imaging (R90-R93)

• Edema (R60.-)
• Enlarged lymph nodes (R59.-)
• Localized adiposity (E65)
• Swelling of joint (M25.4-).

An example of when R22.0-R22.1 could be appropriate is a situation where a patient falls and bumps his head, leading to swelling. He presents to the emergency department and the treating physician orders a CT to help evaluate the injury. The radiologist finds no acute findings, so the appropriate code for the claim is the sign or symptom (R22.0) leading to the exam.

Code R90.0 would be more appropriate in a case where the radiologist images the brain and/or spine and documents discovery of an intracranial space occupying lesion (without a more specific diagnosis).

Don't miss: ICD-10 also provides a code that crosses to 793.0 (Nonspecific [abnormal] findings on radiological and other examination of skull and head). That code is R93.0 (Abnormal findings on diagnostic imaging of skull and head, not elsewhere classified). Code R93.0 specifically excludes "intracranial space-occupying lesion found on diagnostic imaging (R90.0)."

Remember: When ICD-10-CM goes into effect on Oct. 1, 2013, 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.