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Preparations Continue for ICD-10-CM: Changes in Store for Skin Specimens

October 24, 2013

cmslogoThe US Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10-CM code sets.  The number of diagnosis codes will increase from approximately 13,600 to 69,000.  The implementation date set by HHS is October 1, 2015, and after years of transition, diagnoses and inpatient procedures will be reported with the new coding system.  ICD-10-CM implementation will radically change the way coding is currently done and will require a significant effort to implement.

Incyte Diagnostics has successfully completed the conversion to HIPAA Compliance Federation of America (HCFA) 5010 and is looking ahead toward ICD-10-CM.  Payers will switch to ICD-10-CM beginning Oct. 1, 2015; and large payers must have a Health Plan Identifier by then, too. This date may seem way off in the future, but as with most things procrastinated, it is sneaking up on us.  Incyte Diagnostics would like to assist you in preparing for the changes now with this series of helpful articles.

The ICD-10-CM diagnostic classification is more specific and provides a better clinical picture to support optimal quality of care and reimbursement.  ICD-10-CM has far greater granularity and more current healthcare information and, as a result, the language has changed to reflect more site specificity and more disease specificity.  In this article, we will highlight some of the changes that will affect skin conditions, biopsies and excisions.

As noted, you can expect that further site detail will be required in ICD-10-CM over ICD-9-CM.  Laterality is a good example. Site-specific laterality has been added in ICD-10-CM.  Conditions such as fractures, burns, and pressure ulcers will indicate right side vs. left side and in some cases, bilateral sites.  Coding professionals will need to note the laterality of diseases or disorders that are documented in the medical record when coding with ICD-10-CM.

It should be noted, that there is fifth character agreement between ICD-9 and ICD-10 for the following codes:

    • 0 = Unspecified malignant neoplasm of …
    • 1 = Basal cell carcinoma of …
    • 2 = Squamous cell carcinoma of …
    • 9 = Other specified malignant neoplasm of …

Coding Skin Lesions – Sixth Character

An example of the new specificity is the addition of a sixth character to further designate a skin lesion site.  Your choices for the additional character in this example include:

    • 1 = Unspecified
    • 2 = Right
    • 9 = Left
ICD-9-CM      Skin Lesion Site ICD-10-CM
173.0 Lip C44.0_
173.1 Eyelid, including canthus C44.1_
173.2 Ear and external auditory canal C44.2_
173.3 Other & unspecified parts of face C44.3_
173.4 Scalp and skin of neck C44.4_
173.5 Skin of trunk, except scrotum C44.5_
173.6 Skin of upper limb, including shoulder C44.6_
173.7 Skin of lower limb, including hip C44.7_
173.8 Other specified sites of skin C44.8_
173.9 Skin, site unspecified C44.9_

Neoplasms – Include Laterality Codes

Condition ICD-9-CM      ICD-10-CM
Malignant melanoma of back 172.5 C43.59
Squamous cell carcinoma in situ, skin of neck 232.4 D04.4
Malignant basal cell carcinoma, skin of lip 173.0 C44.01
Merkel cell carcinoma of cheek 209.31 C4a.39
Melanoma in situ of left shoulder 172.6 D03.62
Benign lipomatous neoplasm of skin and subcutaneous tissue, right leg 214.1 D17.23
Malignant neoplasm of skin of scrotum 187.7 C63.2

Additional Resources Available

Our coding staff has already begun the training process and is preparing to take recertification tests with the American Academy of Professional Coders (AAPC). The Incyte Diagnostics website (www.incytediagnostics.com) lists helpful resources including links to the AAPC, CMS and WHO educational pages.  You can find these by clicking on the News tab along the top of our main page, then choosing ICD-10-CM from the drop down menu.

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