More than two years of advocacy by the DTRF has led to the approval by the Center for Disease Control (CDC) of new codes specific to the diagnosis of desmoid tumor, which also identify tumor location.
What are ICD-10 Codes?
Diagnosis codes are the administrative language of healthcare in the U.S. As mandated under HIPAA, they are used in billing, medical policy, coverage, and payment. By identifying desmoid tumors distinctly and by location, the new codes will improve communication, reduce administrative work, and improve claims processing efficiency, all of which benefit patients in the long run. Distinct codes will also allow researchers to analyze “real world” data on desmoid tumors toward a better understanding of its course and the effectiveness of treatments.
New Desmoid Tumor ICD-10-CM Codes
Watch as Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, COC, of Clarity Coding presents at the 2023 DTRF Int’l Research Workshop.
The new codes are shown below.1 They are defined exclusively for desmoid tumors and also identify the anatomic site of the tumor. The actual code numbers are inside the red brackets. Note that all codes have six characters numbering from D48.110 to D48.119.
- D48.1 Neoplasm of uncertain behavior of connective and other soft tissue
- D48.11 Desmoid tumor
- D48.110 Desmoid tumor of head and neck
- D48.111 Desmoid tumor of chest wall
- D48.112 Desmoid tumor, intrathoracic
- D48.113 Desmoid tumor of abdominal wall
- D48.114 Desmoid tumor, intraabdominal Desmoid tumor of pelvic cavity
- Desmoid tumor of pelvic cavity
- Desmoid tumor, peritoneal, retroperitoneal
- D48.115 Desmoid tumor of upper extremity and shoulder girdle
- D48.116 Desmoid tumor of lower extremity and pelvic girdle
- Desmoid tumor of buttock
- D48.117 Desmoid tumor of back
- D48.118 Desmoid tumor of other site
- D48.119 Desmoid tumor of unspecified site
- D48.19 Other specified neoplasm of uncertain behavior of connective and other soft tissue
- D48.11 Desmoid tumor
Important Coding Points2
- “Uncertain behavior” refers to tumors whose histology cannot be formally classified as benign or malignant. Desmoid tumors are not malignant, but they are nonetheless locally aggressive, infiltrative, and destructive.
- The notes under D48.114 mean that, in addition to intra-abdominal desmoid tumors, pelvic, peritoneal, and retroperitoneal desmoid tumors will also use D48.114.
- Likewise, the note under D48.116 means that, in addition to desmoid tumors of the lower extremity and pelvic girdle, desmoid tumors of the buttock will also use D48.116.
- Multiple codes from D48.110 through D48.118 can be assigned if the patient has desmoid tumors at multiple sites, as long as each site is clearly documented.
- Providers and coders should try not to default to D48.119, Desmoid tumor of unspecified site! For accuracy, it is important for physicians to clearly document the specific site or sites of the desmoid tumors.
- D48.1 was the code previously used for desmoid tumors, but it is no longer a valid code as of October 1, 2023. As shown above, D48.1 will stay in the codebook but will be converted from a code into a category heading. If D48.1 is submitted on or after October 1, 2023, it will be rejected as invalid because it is no longer a code.
- Similarly, D48.11 is no longer a valid code. As shown above, it is a category heading, not a code. If D48.11 is submitted on or after October 1, 2023, it will be rejected as invalid because it is not a code.
- In addition to the new desmoid tumor codes, D48.19 is a new code. It is assigned for other connective and soft tissue tumors that are not desmoid tumors.
How This Came About
- The ICD-10 Coordination and Maintenance Committee, a Federal interagency group, manages the use of ICD-10 codes in the US and makes all final decisions on creation, revision, and deletion of codes.
- The CDC and CMS jointly co-chair the Committee. However, the CDC is directly responsible for diagnosis codes.
- There is an established and rigorous multi-step process that requestors must go through to request code changes.
- The Desmoid Tumor Research Foundation formally requested creation of new codes in March 2022, and successfully shepherded the request through each step of the process to approval by the CDC.
U.S. Coding VS. International
- The new ICD-10-CM codes apply only to the United States. However, other countries which currently use ICD-10 may consider adopting the new codes into their own coding systems.
- Many countries are already using the international WHO version of ICD-11, which has several codes for desmoid tumors but still lacks specificity. It is possible the new codes in the US may provide leverage to expand the WHO ICD-11 codes.
More Information on the New Codes
Physician specialty societies, professional coder associations, and insurance organizations all routinely engage in widespread educational efforts to prepare their members for code updates and will be doing so for the new desmoid tumor codes.
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References
- ICD-10-CM Tabular List of Diseases and Injuries https://www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10-CM-Files.htm
- ICD-10-CM Official Guidelines for Coding and Reporting FY2024 – Updated October 1, 2023 https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2024/ICD-10-CM-Guidelines-October%201%20FY2024.pdf See guidelines I.A.2, I.A.3, I.A.11, I.B.2, I.B.18, I.C.2.
