The application of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) became mandatory in the U.S. on Oct. 1, 2015. Those who attended NCRA’s 2015 Conference in San Antonio were able to hear an excellent presentation by HIMagine Solutions on this important subject. For those registrars who missed it, some tips to help prepare for the transition are outlined below.
The good news is that cancer registries have been using ICD-10 for many years, and the U.S. version being adopted has a great deal in common with the familiar ICD-O 3rd Edition. The three-volume new edition has a listing of morphology codes in the back of Volume 1. Registrars will find that most malignancies have a morphology code notation in the alphabetic index in Volume 3.
Inpatient & Outpatient Coding
For those registrars using Healthcare Common Procedure Coding System (HCPCS) Level 3 or Current Procedural Terminology (CPT) codes for outpatient casefinding, these systems will remain unchanged and the move to ICD-10 should not affect data capture for outpatient “J” codes or procedure codes.
Inpatient procedure codes will convert to ICD-10 Procedure Coding System (PCS) codes and will require updating. Be especially aware that American spelling is used in the Index, and British spelling is used in the Tabular List. Volume 2 has guidelines and instructions for coders, but registrars may wish to read through this volume, so they can become more familiar with how these codes are used. Electronic copies are available free on the CDC website: http://www.cdc.gov/nchs/icd/icd10cm.htm
SEE ALSO: The Case for Cancer Registry Automation
The new system has a somewhat different structure from ICD-9. The standardization of code structure should help registries with casefinding and information gathering. All codes start with an alpha character, followed by at least two numeric characters. For neoplasms, the starting alpha character will be either “C” or “D”. “History of” codes start with a “Z”. These first three characters are used for international reporting and comparisons.
Additional characters provide greater specificity, particularly for U.S. reimbursement applications, and should prove useful for registrars as well. They can be used to signify patient sex, indicate laterality, or a sub-site, etc. After the first three characters, there is a decimal point, similar to current codes. The “___.8” suffix will appear very familiar to registrars; it indicates contiguous overlapping sites for neoplasms. D00-D09 are for use with In Situ neoplasms, and D10-D36 are for use with benign neoplasms. C00-C97 are for malignant neoplasms. Surveillance, Epidemiology, and End Results (SEER) Program has an updated casefinding list for 2015 ICD-10 codes; it is available on their website at: http://seer.cancer.gov/tools/casefinding/ .
Special Disease Categories
In the new system, special disease categories take priority over body systems when choosing the appropriate code. For most neoplasms, registrars will go by body system, but for leukemias, lymphomas, and hematopoietic diseases, registrars will follow the special disease rules and use codes C81-C96, as these conditions affect lymph and blood and are more systemic in nature. Do not use the Table of Neoplasms, which is available as a separate volume, for these conditions. Registrars should use Volume 3, the Alphabetic Index, to look-up the correct code.
Registrars need to be aware of one unusual feature that may impact casefinding. In ICD-10, the code C97 is for use where there are multiple malignant neoplasms of independent sites, or, in more familiar terms, multiple synchronous primaries. So be alert if this code comes up on casefinding lists and be prepared to assign the correct primary site codes. For those with automated casefinding, registrars may wish to review these cases to ensure accurate case numbers on suspense lists. Coders have the option of assigning separate codes for each primary, so make sure to ask coders which method they prefer to use.
C80 is still used for malignant neoplasm with no specification of site (unknown primary), but it has been expanded. This is a useful section to become familiar with as carcinomatosis, cancer, NOS, and other conditions are now covered by these codes.
C7A is a special code used for malignant neuroendocrine tumors. Instructions in this section remind coders to capture any associated syndromes, such as carcinoid syndrome. Registrars should review this section very carefully, as there are several exclusions and many sub-site codes.
A couple of other features with ICD-10 include instructions in the code descriptions to code tobacco and alcohol use/abuse/dependence. There are even notes regarding using code Z57.31 to capture occupational exposure to cigarette smoke, which will make it easier for those registries that still require this info to do so. Exclusion notes also remind coders to refer to special disease codes and not to use the body system codes for malignancies that involve neuroendocrine tumors, sarcomas, lymphomas, etc. There are also reminders to code secondary involvement, using codes from C77-C79.9.
For National Accreditation Program for Breast Centers (NAPBC)-approved programs, registrars may wish to review D24 to see which benign conditions are included, as it appears many breast diseases are now coded to N60, including fibrocystic disease.
Registrars can download a free electronic copy of the three volumes and the Table of Neoplasms. Make sure to review the new codes. If one struggled to understand ICD-9, ICD-10 will be a pleasant surprise. It will look familiar, but it is more organized. Once registrars get used to the new look and feel of these codes, they will see the benefits from the change and be more inclined to use billing codes to help supplement special casefinding ventures and reports to administrators.
NCRA’s 2015 Annual Conference DVD includes the HIMagine Solutions session on ICD-10. To order, go to www.ncra-usa.org/store and search the “Encore Sessions” category.
Holly J. Kulhawick is Supervisor, Cancer Registry, Renown™ Health, Reno, Nevada.