Top Ten ICD-10 Tips for Oncology Practices

1. Don’t ignore ICD-10. It’s coming in a matter of weeks. If oncology practices haven’t yet begun the transition, it’s imperative that they start now. Ensure that coding staff members have proper training so they can, in turn, educate physicians. Physicians may also require separate specialty-specific training. Next, begin documentation reviews to focus on diagnosis code changes in ICD-10-CM.

2. Document laterality and the specific area of the breast in which cancer is present (eg, nipple and areola, central portion, lower inner quadrant). Note that many other types of malignant neoplasms require this information as well. Take the time to review the coding book to familiarize yourself with these changes.

3. For primary liver cancer, document the specific type of cancer.

4. Document the specific portion of the colon in which a benign neoplasm exists. ICD-10 includes the following options: cecum, appendix, ascending colon, transverse colon, descending colon, and sigmoid colon, and unspecified. This information was not required in ICD-9.

5. Lymphoma codes require documentation of the type of lymphoma as well as anatomical specificity.

6. Note that Sickle-cell disorders are combination codes. Document the type of disease, with or without crisis, and the specific type of crisis.

7. In ICD-10, if a patient is admitted for treatment of anemia due to or associated with a malignancy, report the malignancy as the primary diagnosis. Note that this is the opposite of what ICD-9-CM guidelines require.

8. Review templates and superbills to identify code changes, including requirements for additional specificity. Many oncology codes require laterality and anatomical detail. Other codes are completely new, such as those that denote specific types of male breast cancer.

9. Ask coders to create cheat sheets and work with the practice’s EHR vendor to ensure that any electronic templates have been updated.

10. Don’t get overwhelmed. The ICD-10 transition is completely manageable. However, practices need to act now. Waiting until after the go-live date to “figure it out” is not advisable.