2012 ICD-9 Code Changes Bring Significant
Changes for Pathology / Lab Coding

October 2011
Management Home Page 

By Laura Edgeworth, HTL (ASCP), CPC, PSA Coding Compliance Manager

The 2012 edition of the ICD-9-CM code book will include significant changes to pathology and laboratory coding. These coding changes will become effective October 1, 2011 and we have summarized the most noteworthy changes below. A complete listing of all code changes can be downloaded here.

Primary Malignancy-Skin
A total of 40 new codes have been added to the 173 code series (Other malignant neoplasm of skin). Prior to this update, ICD provided classifications for malignant melanomas (172.0-172.9), Kaposi’s sarcoma (176.0), and Merkel cell carcinoma (209.31-209.36), while all other skin cancers were assigned to the 173 code series. This code assignment was particularly problematic for tumor registries, as neither squamous cell nor basal cell carcinoma qualify as reportable conditions. Many hospitals identify their tumor cases with the use of diagnosis codes alone, and this creates additional work, as registrars must review all records to ensure accurate reporting. In some cases, all data is automatically transferred to the registry, resulting in the unnecessary transmission of confidential patient information. These issues led the New York State Cancer Registry to request an expansion of the 173 code series for 2012. As a result, the 173 code series has been expanded to five digits. For example, squamous cell carcinoma of the ear was previously reported as 173.2 (Malignant neoplasm of skin, skin of ear and external auditory canal). Code 173.22 (Squamous cell carcinoma of skin of ear and external auditory canal) should be reported as of October 1, 2011.

Pilar/Trichilemmal Cyst
The National Center for Health Statistics requested the addition of codes for reporting of pilar and trichilemmal cysts. Pilar cysts have been reported under code 706.2 (Sebaceous cyst); however, Pilar cysts are actually epidermal cysts which have the rare potential of developing into proliferating tumors known as proliferating trichilemmal cysts. Codes 704.41 (Pilar cyst) and 704.42 (Trichilemmal cyst) were created to better capture data on these specimens.

ICD-9-CM has historically only provided one code for the reporting of non-sickle cell related thalassemia (282.49). This code was reported for asymptomatic patients (silent carriers or thalassemia traits) as well as those with severe disease (thalassemia major). Six new codes have now been added to the 282.4 series to allow better tracking of the different types of thalassemia. See codes 284.00-282.47 for details.

Drug-induced pancytopenia has previously been reported under code 284.89 (Other specified aplastic anemia). However, pancytopenia related to drugs is not always related to aplastic anemia. The 284.1 (Pancytopenia) code series has been expanded to include drug-induced pancytopenias. After October 1, 2011, anti-neoplastic chemotherapy induced pancytopenia will be reported as 284.11, while other drug-induced pancytopenia will be reported as 284.12. Code 284.19 will continue to be reported for other pancytopenias. Please note that aplastic anemia due to drugs will continue to be reported as 284.89.

Solitary Pulmonary Nodules (SPN)
Advancements in Computed Technology (CT) and Positron Emission Tomography (PET) scans have led to an increase in identification of solitary pulmonary nodules (versus that of X-rays). Research has shown that 25-35% of SPNs located deep within the lung tissue are benign. In addition, lung cancer patients with tumors detected at stage 1A have five year survival rates of 70%. The current ICD-9 only recognizes “coin lesion” under code 793.1 (Nonspecific (abnormal) findings on radiological and other examination of lung field). The 793.1 code series will be expanded to include new code 793.11 (Solitary pulmonary nodule) and 793.19 (Other nonspecific abnormal finding of lung field). This will allow a higher level of specificity for classification while also allowing for better tracking for research purposes.

Lymphangioleiomyomatosis (LAM) and Adult Pulmonary Langerhans Cell Histiocytosis (PLCH)
ICD-9-CM currently does not provide specific codes for Lymphangioleiomyomatosis or Adult Pulmonary Langerhans Cell Histiocytosis. Both diseases are consistent with interstitial lung disorders, although they are currently indexed to other areas of the code book. LAM is currently classified as a malignant neoplasm of connective and other soft tissue, site unspecified. PLCH is an interstitial lung disorder occurring almost exclusively in smokers. Current code selections for histiocytosis lead users to neoplasms, metabolic disorders, or the pediatric form of the disease. These diseases will now be reported as 516.4 (Lymphangioleiomyomatosis) and 516.5 (Adult pulmonary Langerhans cell histiocytosis) for 2012.

Anaphylactic and serum reactions
Codes 999.41 (Anaphylactic reaction due to administration of blood and blood products) and 999.51 (Other serum reaction due to administration of blood and blood products) have been added to distinguish between the different types of reactions occurring after the transfusion of blood or blood products. Anaphylactic reactions are a type I sensitivity occurring immediately with exposure and involving IgE antibodies. Code 999.41 should be reported for this type of reaction. A Type II reaction involving IgG antibodies should be reported with code 999.51.

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