For professionals in medical coding and gynecologic oncology, accurate diagnosis coding is crucial. A significant update in the ICD-10 coding system addresses a previous gap: the lack of specific codes for bilateral ovarian cancer. This article, based on insights from experts like Bridget Toomey, MS, CPC, CPB, CPPM, CPCO, AAPC Fellow, clarifies these important changes effective from October 1, 2021. Previously, while it was well-acknowledged that many ovarian cancers are bilateral, the ICD-10 terminology did not offer a distinct code to reflect this. Responding to the appeals from organizations like the SGO Coding and Reimbursement Subcommittee, the Centers for Medicare & Medicaid Services (CMS) has introduced new codes in the FY22 updates to more accurately capture bilateral ovarian cancer diagnoses.
Key Updates in Ovarian Cancer Diagnosis Codes
The FY22 ICD-10 updates include additions specifically for bilateral ovarian malignancies, both primary and secondary. This update, a result of requests made by the SGO coding committee back in 2019, includes the following new codes under the Malignant neoplasm of ovary (C56) and Secondary malignant neoplasm of other and unspecified sites (C79) categories:
Primary Malignant Neoplasm of Bilateral Ovaries
Within the C56 category (Malignant neoplasm of ovary), a new code has been introduced to specifically denote bilateral cases:
- C56.3 Malignant neoplasm of bilateral ovaries – New Code
This addition complements the existing codes for malignant neoplasms of the right ovary (C56.1), left ovary (C56.2), and unspecified ovary (C56.9). It is crucial to note that the laterality assignment of ovarian cancer should be determined by the Gynecologic Oncologist. These codes are designed to specify the site of the primary malignancy, not metastatic sites. Given that ovarian cancers are frequently diagnosed at advanced stages and are often bilateral, this new code, C56.3, allows for a more precise recording of the condition. The use of the unspecified code, C56.9, should now be less frequent as detailed diagnostic data usually reveals the affected side(s).
Secondary Malignant Neoplasm of Bilateral Ovaries
Similarly, under the C79 category (Secondary malignant neoplasm of other and unspecified sites), which is used when cancer has metastasized to the ovary, a new code has been added for bilateral secondary malignancies:
- C79.63 Secondary malignant neoplasm of bilateral ovaries – New Code
This code falls under the broader category of C79.6 Secondary malignant neoplasm of ovary, and alongside codes for unspecified (C79.60), right (C79.61), and left (C79.62) ovary. When utilizing these codes, it’s important to also include the appropriate code for the primary cancer site (e.g., breast cancer, colon cancer) to provide a complete diagnostic picture.
Bridget Toomey, MS, CPC, CPB, CPPM, CPCO, AAPC Fellow, expert in gynecologic oncology coding, discussing ovarian cancer diagnosis code updates.
Importance of Accurate Ovarian Cancer Diagnosis Coding
These ICD-10 updates are significant for several reasons. Firstly, they enable healthcare providers to more accurately document and code bilateral ovarian cancer, reflecting the clinical reality more closely. Secondly, precise coding is essential for data collection and analysis, which in turn informs research, treatment strategies, and healthcare policy related to ovarian cancer. Finally, accurate coding ensures appropriate reimbursement and reduces coding ambiguity.
For a comprehensive understanding of all ICD-10-CM changes effective from October 1, 2021, please refer to the CMS website. These updates in Ovarian Cancer Diagnosis Codes represent a positive step towards more accurate and representative medical coding practices.
