ICD-10-CM: 172.4 and C43.4 Vary in 1 Main Way for Melanoma Coding

Plus: Get an up-to-date on the proposed implementation date.

News flash: On April 9, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius declared a proposed rule that includes a new ICD-10 implementation date: Oct. 1, 2014.

In case the new date has you feeling motivated to step up your preparations, check out this review of coding melanoma of the scalp and neck. It discloses how corresponding ICD-9 codes and ICD-10 codes with similar definitions may include dissimilar diagnoses.

ICD-9 Code:

• 172.4 (Malignant melanoma of skin of scalp and neck)

ICD-10 Codes

• C43.4 (Malignant melanoma of scalp and neck)
• D03.4 (Melanoma in situ of scalp and neck)

ICD-9-CM coding rules: ICD-9-CM teaches you to include melanocarcinoma, melanoma in situ of skin, and melanoma (skin) NOS under ICD-9 code 172.x (Malignant melanoma of skin).

ICD-10-CM changes: The dissimilarity between your choices of ICD-9 codes and ICD-10codes for this particular diagnosis is that ICD-10-CM does not include melanoma in situ (D03.-) from C43.- (Malignant melanoma of skin).

For melanocarcinoma the ICD-10-CM index entry tells you to "see melanoma." So for that diagnosis you’ll choose the accurate code from the melanoma entry and then substantiate your choice in the tabular listing.

Documentation: While selecting your ICD-10-CM code, you will first require confirming that whether the location of the melanoma is the scalp or neck. After that you will be required to determine whether the melanoma is documented as "in situ." The National Cancer Institute specifies that melanoma in situ is stage 0 melanoma. The abnormal cells are located in the epidermis in stage 0 melanoma.

As a medical oncology coder, you’re more expected to see a patient diagnosed with melanoma (not in situ) and most probably it will have metastasized. In case the oncologist documents stage I or above, or specifies the melanoma has metastasized, you’ll know that the melanoma is not in situ.

Medical Billing and Coding Tip: Code C43.- does not include melanoma in situ using an Excludes1 note. It specifies that the excluded diagnosis (D03.-, melanoma in situ) must never be used at the same time as the code that has the Excludes1 note (C43.-). Excludes1 is used once two conditions cannot take place together, for instance a congenital form and an acquired form of the similar condition.

Remember: While ICD-10-CM goes into effect, you must apply the code set and official guidelines in effect for the date of service reported to ensure accurate medical billing and coding.