April 3, 2012

ICD-10-CM Coding for Melanoma and Melanoma in Situ

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I have been working with ICD-10-CM for about two years, creating educational resources and tools. With each ICD-10-CM draft update and with each new educational resource or tool I work on, I learn something new. Most recently I have been reviewing ICD-10-CM Chapter 2: Neoplasms (C00-D49). Last month I provided a brief overview of the neoplasm chapter guidelines and a checklist to help identify some of the more specific classifications for neoplasms. This month I am providing more information on coding for melanoma (also referred to as melanocarcinoma) and for melanoma in situ in ICD-10-CM.

Definitions

Melanoma in situ is malignant neoplasm of melanin (brown pigment producing) cells, documented as in situ. This includes melanoma described as follows:

  • Stage 0;
  • Tis (tumor in situ); and
  • Epidermal layer only.

Malignant melanoma is malignant neoplasm of melanin (brown pigment producing) cells, described as having invaded the dermis or as one of the following stages:

  • Stage I – Localized
    • Stage IA – Less than 1.0 mm thick, no ulceration, no lymph node involvement, no distant metastases.
    • Stage 1B – Less than 1.0 mm thick with ulceration or less than 2.0 mm thick without ulceration, no lymph node involvement, no distant metastases.
  • Stage II – Localized
    • Stage IIA – 1.01-2.0 mm thick with ulceration, no lymph node involvement, no distant metastases.
    • Stage IIB – 2.01-4.0 mm thick without ulceration, no lymph node involvement, no distant metastases.
    • Stage IIC – Greater than 4.0 mm thick with ulceration, no lymph node involvement, no distant metastases.
  • Stage III – Tumor spread to regional lymph nodes, or development of in-transit metastases or satellites without spread to distant sites. Three substages include IIIA, IIIB and IIIC.
  • Stage IV – Tumor spread beyond regional lymph nodes with metastases to distant sites.

ICD-9-CM versus ICD-10-CM

In ICD-9-CM, Category 172 is specific to general body sites and includes both malignant melanoma that has invaded deeper layers of skin beyond the top layer and melanoma in situ (Stage 0, top layer of skin only).

In ICD-10-CM, documentation is required specifying whether the melanoma is in situ (D03.-) or has invaded deeper layers of skin (C43.-). Coding of body sites is much more specific and requires documentation of laterality for paired body parts (eyes, ears, upper limb, lower limb, etc.).

 


 

Coding and Documentation Requirements

The two checklists below outline the documentation elements required to assign the most specific codes available in ICD-9-CM and in ICD-10-CM.

ICD-9-CM Coding and Documentation Requirements

  • Identify site as:
    • Lip
    • Eyelid
    • Ear/external auditory canal
    • Other/unspecified parts of face
    • Scalp/neck
    • Trunk, except scrotum
    • Upper limb, including shoulder
    • Lower limb, including hip
    • Other specified/overlapping sites
    • Unspecified site

ICD-10-CM Coding and Documentation Requirements

  • Identify stage or depth of lesion
    • Melanoma in situ (Stage 0, classification TIS or epidermal layer only)
    • Malignant melanoma (Stages I-IV or invasion of dermal layer)
  • Identify site as
    • Lip
    • Eyelid
      • Right
      • Left
      • Unspecified
      • Ear/external auricular canal
        • Right
        • Left
        • Unspecified
      • Nose
      • Other specified parts of face
      • Unspecified parts of face
      • Scalp/neck
      • Anal skin
      • Breast
      • Other parts of trunk
      • Upper limb, including shoulder
        • Right
        • Left
        • Unspecified
      • Lower limb, including hip
        • Right
        • Left
        • Unspecified
      • Overlapping sites
      • Unspecified site

Coding Scenario

Consider the following scenario: a 45-year-old Caucasian female presents to dermatologist’s office for annual skin check. At that time, a 0.5 x 1 cm scaly brown patch of skin on the dorsal aspect of right foot is noted. The lesion is biopsied and sent to pathology. Pathology report indicates melanoma on the epidermal layer only. The patient returns for a wide excision of the right foot lesion. Incision lines are marked with surgical ink and the area is prepped, draped and infiltrated with local anesthetic. The lesion is excised using an elliptical incision with 1 cm clear margins on all sides. A specimen is sent to pathology. The incision is undermined and closed in layers. Sterile dressing is applied. Final diagnosis, per pathology report: melanoma Stage 0, right dorsal foot.

Malignant Melanoma/Melanoma in Situ Lower Extremity

ICD-9-CM Code/Documentation

ICD-10-CM Code/Documentation

172.7 Malignant melanoma of lower limb, including hip

 

C43.70 Malignant melanoma of unspecified lower limb, including hip

C43.71 Malignant melanoma of right lower limb, including hip

C43.72 Malignant melanoma of left lower limb, including hip

D03.70 Melanoma in situ of unspecified lower limb, including hip

D03.71 Melanoma in situ of right lower limb, including hip

D03.72 Melanoma in situ of left lower limb, including hip

ICD-9-CM Diagnosis Codes:
172.7 Malignant melanoma of lower limb, including hip

ICD-10-CM Diagnosis Codes:
D03.71 Melanoma in situ of right lower limb, including hip

Summary

Stage 0 melanoma is a very early-stage disease known as melanoma in situ. In ICD-10-CM, codes for melanoma in situ are found in category D03. Patients with melanoma in situ are classified as TIS (tumor in situ). The tumor is limited to the top layer of the skin (epidermis) with no evidence of invasion of dermis, surrounding tissues, lymph nodes or distant sites. Melanoma in situ presents very low risk for recurrence or metastasis.

About the Author

Lauri Gray, RHIT, CPC, has worked in the health information management field for 30 years. She began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Most recently she has worked as a clinical technical editor of coding and reimbursement print and electronic products. She has also taught medical coding at the College of Eastern Utah. Areas of expertise include: ICD-10-CM, ICD-10-PCS, ICD-9-CM diagnosis and procedure coding, physician coding and reimbursement, claims adjudication processes, third-party reimbursement, RBRVS and fee schedule development. She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

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