PATHOLOGY ICD-10-CM CODING – What You Need to Know

3/31/2012 – CMS has announced a potential delay in ICD-10 implementation beyond October 1, 2013. But if you have not yet begun planning for this change, you are already behind schedule! Every specialty will be affected by the transition from ICD-9 to ICD-10.

The wide range of diagnoses that cause referring physicians to order laboratory tests translate to a big impact for pathologists. And how well you document for ICD-10 will determine whether or not you get paid.

This is a first in a series of articles to describe the conversion from ICD-9 to ICD-10. We will present diagnosis scenarios for some of the most common diagnoses for pathology in ICD-9 and then in ICD-10. This should help illustrate the differences in coding and, more importantly for you, in documentation.

In general, a physician’s documentation for ICD-10 will need to be more specific and detailed than is required for ICD-9. This may mean capturing new information about the patient’s condition that the pathologist never documented before or updating, modifying and expanding his/her documentation. Physicians with good documentation habits will find the transition much easier than those who use abbreviations or other shortcuts. For pathologists, capturing more detailed diagnosis information from referring physician orders will be a particular challenge.

The codes will change in many ways, such as longer code structure, use of laterality, combination codes, and types of encounters. However, one thing remains consistent. No code is ever considered valid or complete unless it’s coded to the highest level of specificity in its category.

Under ICD-10-CM, pathologists must clearly document the diagnosis as well as the procedure performed. Not only does ICD-10-CM have a greater level of specificity than ICD-9-CM, it also has a general disdain for unspecified codes.

The following are examples of diagnoses that we currently see in pathology reports:

ICD-10 EXAMPLES FOR PATHOLOGISTS:

CARCINOMA IN SITU OF BREAST
ICD-9:    2330 – Carcinoma in situ of breast

ICD-10:  D05: Carcinoma in situ of breast (This is not a billable ICD-10 code and cannot be used to indicate a diagnosis. It is only used as the title heading for Carcinoma in situ of the breast). The following are billable codes.
D05.0 –   Lobular carcinoma in situ of breast
D05.00 – Lobular carcinoma in situ of unspecified breast
D05.01 – Lobular carcinoma in situ of right breast
D05.02 – Lobular carcinoma in situ of left breast
D05.1 –   Intraductal carcinoma in situ of breast
D05.10 – Intraductal carcinoma in situ of unspecified breast
D05.11 – Intraductal carcinoma in situ of right breast
D05.12 – Intraductal carcinoma in situ of left breast
D05.8 –   Other specified type of carcinoma in situ of breast
D05.80 – Other specified type of carcinoma in situ of unspecified breast
D05.81 – Other specified type of carcinoma in situ of right breast
D05.82 – Other specified type of carcinoma in situ of left breast
D05.9 –  Unspecified type of carcinoma in situ of breast
D05.90 – Unspecified type of carcinoma in situ of unspecified breast
D05.91 – Unspecified type of carcinoma in situ of right breast
D05.92 – Unspecified type of carcinoma in situ of left breast

As you can see, there is only one ICD-9 code for reporting carcinoma in situ of the breast but ICD-10 will require reporting carcinoma in situ of the breast in much more specificity:  there are now 16 possible codes.

Although there are codes for unspecified breast and unspecified type of carcinoma, these codes should be used as seldom as possible. Insurance carriers may request medical documentation for more specificity since the specific codes are now available. These types of requests will not only delay reimbursement, but lack of this documentation and coding could result in
denial of claims.

SUMMARY

ICD-10 will radically change the way coding is currently done, could radically affect your reimbursement if not done correctly, and will require significant effort from all. To gear up for this change, AHS coders have been participating in anatomy and physiology review training seminars on a monthly basis since the summer of 2011 and AHS is a beta site for testing Alife’s (now Optum Insight) ICD-10 computer assisted coding system. All coders at AHS will be certified in ICD-10 coding before the implementation date.

However, the time for physicians to begin preparing is now. A good head start to ICD-10 is to review the diagnosis detail currently being received from your high volume referrers. Can you include specific and complete diagnosis information in your pathology reports now? Make it a habit, and you will be much closer to ICD-10 compliance by the implementation date and today’s claims will be cleaner with fewer questions from coders and fewer denials.

Tags: ICD-10, Medical Billing, Pathology Billing & Coding

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