Radiology Coding Alert

Anatomical location and histological features gain importance.

In addition to the extensive revisions proposed for diagnosis codes for Hodgkin’s lymphoma, you will see additions and updates to prostatic dysplasia, and gastrointestinal stromal and caricinoid tumors. Here is a quick review of the anticipated changes.

Look at Histology for Prostatic Dysplasia

ICD-10-CM 2017 adds specificity for prostate dysplasia by deleting N42.3 (Dysplasia of prostate) and replacing it with the following more specific codes:

• N42.30, Unspecified dysplasia of prostate
• N42.31, Prostatic intraepithelial neoplasia
• N42.32, Atypical small acinar proliferation of prostate
• N42.39, Other dysplasia of prostate.

“The expansion would aid in tracking the types of dysplasia of the prostate allowing more specific tracking of types/cause/severity/progression and evolving treatment guideline limitations,” says Kelly C. Loya, CPC-I, CHC, CPhT, CRMA, Managing Director of Pinnacle Enterprise Risk Consulting Services (“PERCS”), a division of Pinnacle Healthcare Consulting.

Find Revisions and New Codes for GI Tumors

In ICD-10-CM 2017, you may find the following new codes describing gastrointestinal stromal tumors. You will choose the appropriate code depending upon the anatomical location of the stromal tumor in the gastrointestinal tract.

• C49.A0, Gastrointestinal stromal tumor, unspecified site
• C49.A1, Gastrointestinal stromal tumor of esophagus
• C49.A2, Gastrointestinal stromal tumor of stomach
• C49.A3, Gastrointestinal stromal tumor of small intestine
• C49.A4, Gastrointestinal stromal tumor of large intestine
• C49.A5, Gastrointestinal stromal tumor of rectum
• C49.A9, Gastrointestinal stromal tumor of other sites

Additionally, mark the revisions below for descriptors of the malignant carcinoid codes:

Currently, the descriptor for C7A.094 reads ‘Malignant carcinoid tumor of the foregut NOS.’ In 2017, ‘NOS’ is substituted with ‘unspecified.’ The new code descriptor for C7A.094 will hence read ‘Malignant carcinoid tumor of the foregut, unspecified.’

Similarly, the new code descriptors for C7A.095 and C7A.096 are the following:

• C7A.095, Malignant carcinoid tumor of the midgut, unspecified
• C7A.096, Malignant carcinoid tumor of the hindgut, unspecified

Do Not Ignore Hepatitis Carrier Codes

According to the new proposed changes, you will see revisions to the Z codes for carriers of viral hepatitis.

Current trends: As of now, you have to identify a ‘carrier of viral hepatitis’ by using an appropriate 5th digit expansion of Z22.5 (Carrier of viral hepatitis), depending on whether the patient is a carrier of hepatitis B, C or some other or unspecified viral hepatitis. Accordingly, you can choose from the following codes:

• Z22.50, Carrier of unspecified viral hepatitis
• Z22.51, Carrier of viral hepatitis B
• Z22.52, Carrier of viral hepatitis C
• Z22.59, Carrier of other viral hepatitis

What you can anticipate: The proposed changes in the new set make it easier to report hepatitis carriers. You will no longer need to identify the hepatitis type. You just have to report Z22.5, irrespective of the type of hepatitis the patient is a carrier of.