Laterality, Anatomical Specificity Important In ICD-10 Oncology Codes
- Breast cancer. ICD-10 code category C50 (malignant neoplasm of the breast) includes anatomical specificity (e.g., nipple and areola, central portion, lower inner quadrant) as well as laterality (i.e., right vs. left) – both of which must be included in medical record documentation. ICD-10 also includes separate codes for male breast cancer, each of which requires anatomical location and laterality.
- Benign neoplasm of the colon, rectum, anus, and anal canal. Oncologists probably aren’t accustomed to documenting the specific portion of the colon in which the neoplasm exists; however, ICD-10 includes separate codes for benign neoplasms of the cecum (ICD-10 code D12.0), appendix (ICD-10 code D12.1), ascending colon (ICD-10 code D12.2), transverse colon (ICD-10 code D12.3), descending colon (ICD-10 code D12.4), sigmoid colon (ICD-10 code D12.5), and unspecified (ICD-10 code D12.6). Documentation specificity is key to ensuring the correct code assignment. Report ICD-10 code K63.5 when a patient has a polyp of the colon.
- Sickle cell anemia. Sickle-cell disorders (ICD-10 code category D57) are combination codes that include the type of disease, with or without crisis, and the specific type of crisis (if applicable). Types of Sickle-cell disease include Hb-SS disease, Sickle-cell/Hb-C disease, Sickle-cell trait, Sickle-cell thalassemia, or other Sickle-cell disorders. Types of crises include acute chest syndrome or splenic sequestration. Attention to detail is critical with these codes.
- Primary liver cancer. ICD-10 code category C22 requires specificity regarding the type of liver cancer, including liver cell carcinoma, intrahepatic bile duct carcinoma, hepatoblastoma, angiosarcoma, or other sarcomas. All of this information is critical for cancer research and treatment.
- Lymphoma. ICD-10 includes several pages of codes denoting various types of lymphoma. Oncologists should review codes in this section—i.e., code categories C81 through C88. Not only do these codes denote the type of lymphoma, but many of them also require anatomical specificity. For example, ICD-10 code C83.12 denotes Mantle cell lymphoma, intrathoracic lymph nodes.
- Malignancy in pregnancy. Oncologists must look beyond the neoplasm chapter in the ICD-10 book to subcategory O9A.1- for malignant neoplasms that complicate the pregnancy, childbirth, or puerperium. Specify the specific trimester to ensure correct code assignment. Malignancy in pregnancy is always listed as the principle diagnosis per the ICD-10-CM coding guidelines regardless of the reason for admission.
Oncologists should also keep the following guideline change in mind related to anemia and malignancy:
In ICD-10, if a patient is admitted for treatment of anemia due to or associated with a malignancy, report the malignancy as the primary diagnosis. Note that this is just the opposite of ICD-9 that requires coders to report the anemia as the principal diagnosis in this instance.
How to prepare
Oncologists and their staff members should consider these ICD-10 tips:
For more ICD-10 tools and resources, visit the ICD-10 Resource Center.