ICD-10 essentials for busy oncologists who would rather be doing something else: Prostate and breast cancers, leukemia


The ICD-10 neoplasm chapter documentation and coding changes come in three basic degrees:

  1. No change whatsoever
  2. A level of detail or two has been added
  3. Holy crap, that is a serious bunch of new stuff!

And the three most common cancers illustrate these degrees of change nicely: prostate cancer (men), breast cancer (women) and leukemia (children).

Malignant neoplasm of prostate
The diagnosis codes for prostate cancer and other common cancers occurring in men – like bladder and stomach – are all unchanged. This is true for most organs in the body that do not have a left and right. So for these conditions, you can keep on coding whichever way works well for you now. Below are a couple of examples from the prostate cancer codes.

C61 Malignant neoplasm of prostate 

Replaces

185 Malignant neoplasm of prostate

D07.5 Carcinoma in situ of prostate

Replaces

233.4 Carcinoma in situ of prostate  

Breast cancer
The main level of detail added here and many other places in ICD-10 is the ability to specify whether a condition is found in the left or right instance of that body part — in this case, the left or right breast, but the same is true for other malignancies like lung cancer.

In addition, some areas of the breast neoplasm classification further specify the type. For example, there are separate codes for ductal carcinoma in situ (DCIS), as well as the lobular variety (LCIS). The DCIS codes are given below. Tumors documented as either carcinoma or adenocarcinoma can use these codes.

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 

Replace

233.0 Carcinoma in situ of breast

Leukemia
I’m fudging a bit here because the most common form of leukemia in children, acute lymphocytic leukemia (ALL), has not changed for ICD-10 — but coding and documentation for the acute myelogenous leukemia codes has gone to town. Some changes are specific to adults, others are specific to children.

First, I’ll show you examples from the ALL subcategory. ICD-10 has preserved the ability to distinguish between leukemia in remission, leukemia in relapse, and leukemia not in remission (the default code). The acute lymphoblastic leukemia codes are below. Coding and documentation is unchanged in ICD-10. ICD-10 updated the code title and used the term “lymphoblastic” instead of “lymphoid.”

C91.00 Acute lymphoblastic leukemia not having achieved remission 

Replaces

204.00 Acute lymphoid leukemia, without mention of having achieved remission   

C91.01 Acute lymphoblastic leukemia, in remission 

Replaces

204.01 Acute lymphoid leukemia, in remission

C91.02 Acute lymphoblastic leukemia, in relapse

Replaces

204.02 Acute lymphoid leukemia, in relapse 

Now on to the acute myelogenous leukemia codes. A new group of leukemia codes has been added for a diagnosis of juvenile myelomonocytic leukemia (JMML). There is nothing in ICD-9 for capturing this information. The code titles are perfectly unambiguous so there is nothing tricky about the documentation needs for these codes. JMML and the status of the disease (e.g., in relapse) will do the job. Here they are.

C93.30 Juvenile myelomonocytic leukemia, not having achieved remission  

Replaces

206.80 Other monocytic leukemia, without mention of having achieved remission

C93.31 Juvenile myelomonocytic leukemia, in remission

Replaces

206.81 Other monocytic leukemia, in remission  

C93.32 Juvenile myelomonocytic leukemia, in relapse  

Replaces

206.82 Other monocytic leukemia, in relapse

There are also new groups of ICD-10 codes available for distinguishing between lymphoblastic leukemias beyond those specified as simply acute or chronic. The sub-types are listed below. There are three codes for each sub-type, specifying whether the disease is active, in remission, or in relapse.

  • Acute lymphoblastic leukemia
  • Chronic lymphocytic leukemia of B-cell type 
  • Prolymphocytic leukemia of B-cell type 
  • Adult T-cell lymphoma/leukemia (HTLV-1-associated) 
  • Prolymphocytic leukemia of T-cell type 
  • Mature B-cell leukemia Burkitt-type
  • Other lymphoid leukemia 
  • Lymphoid leukemia, unspecified

Now that you have seen the changes to leukemia codes in ICD-10, you may think, they don’t even qualify for “holy crap” status, and you are probably right. But there are some amazingly detailed codes in ICD-10 for some of the other cancers of the lymphatic system. Those out there of a masochistic bent should check out the lymphoma codes. Category C82 Follicular lymphoma, is dripping with juicy detail. The subcategories are listed below. There are 10 codes for each sub-type, specifying the affected lymph node region or extranodal region.

  • Follicular lymphoma grade I
  • Follicular lymphoma grade II
  • Follicular lymphoma grade III, unspecified 
  • Follicular lymphoma grade IIIa
  • Follicular lymphoma grade IIIb 
  • Diffuse follicle center lymphoma 
  • Cutaneous follicle center lymphoma 
  • Other types of follicular lymphoma

My next blog is going to highlight some of the new codes commonly used to describe the reason for the visit, aka encounter codes — often the first listed code for an office visit. In ICD-9 they began with a V and so were nicknamed V codes. In ICD-10 they begin with a Z. Because they are so much more specific than their ICD-9 counterparts, Z codes should actually be faster and easier to code.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for the development and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and for the development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and Reimbursement Mappings under contract to CMS and the CDC.  She leads the 3M test project to convert the MS-DRGs to ICD-10 for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health Information Systems blog.