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Description : ICD-O-3 and ICD-10 Coding Guide

Tags : ICD,ICD-O-3,ICD10

Published on : Mar 21, 2023 | Views : 2230 | Downloads : 2

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INTERNATIONAL CLASSIFICATION OF DISEASES FOR ONCOLOGYICD-O-3 & ICD-10 1
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Types of Coding Topography and Morphology Codes - As per International Classification of Diseases - Oncology - Third Edition (ICD-O-3) Topography implies the Site / Organ / Tissue such as Skin/ Lung/ Bone etc. Morphology implies type of malignancy at tissue or cellular level such as Carcinoma/ Sarcoma/ Leukaemia etc A single code as per International Classification of Disease - 10th Revision (ICD-10) Mostly ICD-10 is same as the topography code of ICD-O-3 but in some cases it takes into account morphology also 2
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Why are Two Coding Systems Required ? ICD -10 gives a single code for all diseases by which medical fraternity of the globe understand the same disease in a same way. ICD –O has been made for cancer only keeping in mind both topography and morphology which ICD- 10 cannot provide for all cancer (except few such as Lymphoma, Leukaemia, Mesothelioma, Melanoma skin etc) Such as in ICD-10 , Osteosarcoma of Femur and Ewing`s Sarcoma of Femur will give the same code (C40.2) – all bone cancer of long bone of lower limb. Still we require both the coding for different platforms and different comparison purposes – suppose comparing incidence of diabetes and incidence of pancreatic cancer in a year. 3
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Topography Oesophagus : Middle Third ICD-10 Follows the Same Pattern Lung 4
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Lip, Oral Cavity and Pharynx (C00- C14) Lip – C00 Tongue – C01 – C02 Gum – C03 Floor of mouth – C04 Palate – C05 Oral Cavity – C06 Salivary Gland – C07 –C08 Tonsil- C09 C10 – Oropharynx C11 – Nasopharynx C12 – Pyriform Sinus C13 – Hypopharynx C14 – Pharynx NOS 6
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C15.9 C22.0 C16.9 C18.9 C17.9 C20.9 C21.0 C15-C26 DIGESTIVE ORGANS
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Major Digestive Organs Light Green: Esophagus (C15) Red: Stomach (C16) Pink: Small Intestine (C17) Brown: Large Intestine (C18) Purple: Liver (C22) Deep Green: Gall Bladder (C23) Yellow: Pancreas (C25) 8
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C30-C39 Cardio Respiratory System C33.9 C34.0 C34.1 C34.3 C34.2 C49.9 C49.3 C77.0 C34.9
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C41.0 Skull Mandible C41.1 C41.3 Clavicle C40 - C41 Bones, Joints and Articular Cartilage Sternum C41.3 Ribs C41.3 Vertebra C41.2 C40.0 Ulna Ilium C41.4 Coccyx C41.4 C40.0 Humerus Femur C40.2 Knee C40.2 Fibula C40.2 Tibia C40.2 C40.3 Short Bones - Foot C40.3 C40.3 C40.1 C40.1 Short Bones - Hand C40.1 C41.4 Sacrum
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C77 Lymph Nodes & C42.1 Bone Marrow C09.9 C37.9 C42.2 C42.1 C49.9 C49.9
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Female Reproductive System (C51 –C58) C51 – Vulva C52 – Vagina C53 – Cervix uteri C54 – Corpus uteri C55 – Uterus NOS C56 – Ovary C57.0 – Fallopian Tube C57.1 – Broad Ligament C58 - Placenta 12
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Male Reproductive System (C60 –C63) C60 – Penis C61 – Prostate C62 – Testis C63.0 – Epididymis C63.1 – Spermatic Cord C63.2 – Scrotum C63.7 – Seminal Vesicle 13
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Urinary System (C64 - C68) Kidney – C64.9 Ureter – C66.9 Bladder – C67.9 Urethra – C68.0 14
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Central Nervous System (C70 –C72) Meninges – C70 Brain – C71 - Frontal – C71.1 - Temporal – C71.2 - Parietal – C71.3 - Occipital – C71.4 - Cerebellum – C71.6 - Brain stem – C71.7 Spinal Cord, Cranial Nerves – C72 15
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Endocrine System 16 Pineal Gland- C75.3 Pituitary – C75.1 Thyroid – C73.9 Adrenal – C74 Pancreas – C25 Parathyroid – C75.0 Ovary – C56.9 Testis – C62 Breast – C50
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Topography Codes : ICD – O -3 (1/3) 17
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Topography Codes : ICD – O -3 (2/3) Female organs are in red 18
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Topography Codes : ICD-O-3 (3/3) Male organs are highlighted in blue 19
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Sub-sites Sub-sites refers to specific part of organ or location of a system Sub-site code ranges from 0 - 9 (number may vary with site) Sub-site 8 refers to overlap between two or more sub-sites e.g., Duodeno Jejunal (C17.8) Usually, sub-site 9 refers to - Unspecified / Not otherwise specified (NOS) e.g., - Lung NOS (C34.9) All sites in ICD-O-3 have sub-sites but not in ICD-10 20
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Sites where sub code ‘9’ do not exist in ICD- O- 3 for ‘Not Otherwise Specified (NOS)’ 21
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Organs without Sub-site Codes in ICD-10 All of the above Codes only have sub-site, Code 9 is ICD-O-3 22
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Important Sub-site Mnemonics Oesophagus – 345 C15.3 – Upper third C15.4 – Middle third C15.5 – Lower third Lung – 123 C34.1 – Upper lobe C34.2 – Middle lobe C34.3 – Lower lobe 23
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Morphology Code : ICD-O-3 Well Differentiated Squamous Cell Carcinoma (Primary) Adenocarcinoma (Metastatic) 24
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Searching Morphology Codes in ICD-O-3 Two indices – Morphological Index and Alphabetic IndexIn Morphological Index – codes will appear by numbers ( 8000 to 9990 ) – for cell typesIn Alphabetic index – codes will appear as per the alphabetic order of the description (A to Z) Each morphology code may have many behaviour code [Code – 3 to be considered]Common/Specific sites are mentioned in bracket with certain morphologies – may not be strictly specific. - 8500 (C50) i.e. intraductal Carcinoma (Breast) but may occur in Pancreas (C25) also. 26
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ICD-O-3 : Indices Morphological Index Alphabetic Index 27
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Commonly Used Morphology 28
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Mixed Tumor In some cases, mixed tumor have a single morphology code: e.g. - Papillary and Follicular Adenocarcinoma (Thyroid) - 8340 - Infiltrating duct and Lobular Carcinoma (Breast) – 8522 Otherwise in case of two different morphology component in same tumor - Assign the higher morphology code 29
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Cases Where Nature of Differentiation is Mentioned in the Morphology Code In some cases, nature of differentiation has been included in the morphology code (4 digit) itself. e.g.- 8020 - Carcinoma, undifferentiated, NOS 9511 – Retinoblastoma, differentiated 9512 - Retinoblastoma, undifferentiated 30
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Specific Codes in ICD – O-3 and ICD -10 ICD-O-3 (only) C42 (Hematopoietic system) ICD -10 (only) C43,C45, C46,C81 –C97 C22 (some sub code) C78 –C79 (Secondary) C77 can be used for secondary of lymph node also. 31 In case of secondary (C77 – C79) in ICD-10, ICD-O-3 for primary site is C80.9
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Where ICD-10 Depends on Morphology also 32
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Coding of Common Hematolymphoid Malignancies Lymphoma of an organ will be coded to that organ such as Lymphoma of Stomach- will be coded to Stomach (C16) – NOT C77 33
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Example : Incorrect coding 34
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Example : Hodgkin Lymphoma 35
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Coding of Secondary/Metastatic Tumour If nothing is known regarding the site (Primary or Secondary) of cancer, then PSTT and ICD-10 will be respectively C80.9 (unknown primary site) and C80 (malignant neoplasm without specification of site) If secondary site is known then PSTT will be C80.9 but ICD-10 will be one of the codes of secondary sites (C77, C78, C79) based on Secondary site For secondary neoplasm of lymph nodes, both Secondary Site of Tumor (SST) and ICD-10 will have the same code (C77._) 36
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ICD -10 Coding for Secondary Sites 37
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Example: Secondary Tumor Incorrect Coding 38
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Example: Secondary Tumor 39
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Confusion with Similar Type Terminologies :Topography Same name of parts in different organ: e.g., Frontal bone (C41.0) / Frontal lobe of Brain (C71.1) Gall Bladder (C23.9)/Urinary Bladder (C67.9) Ileum (C17.2) / Ilium (C41.4) Maxilla (C41.0) / Maxillary Sinus (C31.0) Mastoid Antrum (C30.1)/ Pyloric Antrum (C16.3) Thyroid cartilage (C32.3)/ Thyroid gland (C73.9) Key : Look for and code the site first, then the part or sub site such as – Frontal lobe of Brain  Brain (C71)  Frontal lobe (C71.1) 40
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Confusion with Similar Type Terminologies : Morphology Similar terms in different histological connotation: e.g., Spindle Cell Carcinoma (8032) / Spindle Cell Sarcoma (8801) Papillary Adenocarcinoma (8260)/ Papillary serous Adenocarcinoma (8460) Key : Ensure the basic morphology first, then search for the cell type or variant -Spindle Cell Sarcoma - Sarcoma (880)  Spindle Cell Sarcoma (8801) 41
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Some Coding Tips for Morphology 1. Mostly common tumors (Prototype/ NOS) end with a 0 in 4th digit :- e.g.- Squamous Cell Carcinoma (8070), Adeno carcinoma (8140), Osteosarcoma (9180) 2. Mostly Anaplastic variant ends with 1 or 2 in the 4th digit :- e.g.- Carcinoma Anaplastic – 8021, Anaplastic Oligoastrocytoma – 9382 3. Changing the 3rd digit numerically (the code by 10) – common tumors will come:- e.g.- 9400 - Astrocytoma 9410 - Protoplasmic Astrocytoma 9420 - Fibrillary Astrocytoma 9430 - Astroblastoma 9440 - Glioblastoma 9450 - Oligodendroglioma 9460 - Oligodendroblastoma 9470 - Medulloblastoma 9480 - Cerebellar Sarcoma 9490 - Ganglioneuroblastoma 9500 - Neuroblastoma 9510 - Retinoblastoma 42
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43 Thank You!