How the CMS Plans for ICD-10 Implementation Will Affect Hematologists

Jul 7, 2015

The Centers for Medicare and Medicaid Services (CMS) has announced a new plan that will introduce some leniency in the introduction of the new ICD-10 diagnosis coding system. Most notably, claims will not be rejected if the diagnosis coding is not to the correct level of specificity. CMS was particularly influenced in the decision to make this change by the efforts of the American Medical Association (AMA). 

All healthcare related business transactions must convert to ICD-10 coding on October 1, 2015. In many cases, ICD-10 includes more specificity than is available under the ICD-9 coding system. CMS still has to release some of the details of this plan but it may help to look at an example from hematology. For example, look at the diagnosis coding for lymphoid leukemia.

If a patient presents with a mature b-cell leukemia Burkitt type in remission today that would be coded as:

204.81 – Other lymphoid leukemia, in remission

That same code would be used if the patient had a prolymphocytic leukemia of T-cell type or an adult T-cell lymphoma/leukemia. With ICD-10, each of these diseases has their own diagnosis: 

  • C91.51 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission
  • C91.61 Prolymphocytic leukemia of T-cell type, in remission
  • C91.A1 Mature B-cell leukemia Burkitt type, in remission

Even with this greater specificity, ICD-10 retains codes in most cases for those that are not catalogued. So in addition to the codes listed above, there are the codes for other (for those that are not included in the named codes) and for unspecified. Unspecified would only be used if the type is unknown or not documented.

  • C91.Z1 Other lymphoid leukemia, in remission
  • C91.91 Lymphoid leukemia, unspecified, in remission

What CMS appears to be announcing is that the code that does not specify the type of lymphoid leukemia would still be accepted. This will be an important protection as many physician practices are unfamiliar with documenting to this level of specificity. It is also important to note that many code families in ICD-10 are nearly identical to ICD-9 with no greater specificity. Many of the benign blood diseases do not have significant changes or expansion in specificity. 

It is important to note that while ICD-10 will be mandated throughout the health system, the rules on specificity only apply to Medicare. This means that private insurers may require coding to the highest level of specificity. ASH will inform members as it learns of private insurers plans for ICD-10 implementation.