# ICD-9  Help...again!



## valerieeanderson

Ok here's what I have today:

Hypercalcemia secondary to malignancy, history of renal cell cancer, status post nephrectomy in 2008 and recently was found to have pulmonary metases.

Can someone help me break this one down? I think I am just getting overwhelmed by this one, and the rest of the note is huge also any help is appreciated!


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## preserene

Kindly have a look into this:
There is an association between renal cell Carcinoma and hypercalcaemia.
588 Disorders resulting from impaired renal function
588.8 Other specified disorders resulting from impaired renal function
*588.81* Secondary hyperparathyroidism (of renal origin) secondary hyperparathyroidism NOS.
* Our ICD-9 Index points to 588.89*  hypercalcemia- associated with nephropathy.
Now, you yourself can research to select the suitable code.
275.42  though describes clearly hypercalcemia, it is idiopathic; and not so convinced to assign.
Thank You.
[The clinical correlation states thus:
Ionized calcium concentration is closely regulated by two separate but related hormone systems: parathyroid hormone (PTH) and 1,25-dihydroxycholecalciferol (1,25(OH)2D3), or calcitriol. PTH is produced by four parathyroid glands
Hypercalcemia in patients with renal cell carcinoma frequently mimics primary hyperparathyroidism and has been attributed to tumor secretion of parathyroid hormone related protein. Nephrectomy temporarily ameliorated hypercalcemia in a subgroup of patients with metastatic renal cancer and hypercalcemia. Parathyroid hormone related protein expression was commonly found to be associated with hypercalcemia. Nonparathyroid hormone related protein mechanisms of hypercalcemia in renal carcinoma becomes more common than previously thought.. Malignancy associated hypercalcemia is distinguished into two forms: 
Humoral hypercalcemia of malignancy and local osteolytic hypercalcemia. As its name implies, humoral hypercalcemia of malignancy results from the systemic effect of a circulating factor produced by neoplastic cells. The hormone most commonly responsible for this syndrome is parathyroid hormone-related protein (PTHrP).This peptide's N terminal shares  significant homologic features with PTH. In humans, PTHrP serves as a paracrine factor in a variety of tissues, including skin, bone, uterus, breast, and the vasculature. PTHrP shares most, if not all, of the metabolic effects of PTH, including osteoclast activation, increased renal tubular calcium reabsorption, and increased renal clearance of phosphates.
 Causes of malignancy-associated hypercalcemia
Humoral hypercalcemia of malignancy  
PTHrP, Squamous cell carcinoma  Lung  Oral cavity, larynx  Esophagus  Cervix, vulva 
Adenocarcinoma , Breast , Ovary ,*Renal cell carcinoma*  and more ]


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## msrd_081002

*275.42 Hypercalcemia covered when due to malignancy only/J1457*



valerieeanderson said:


> Ok here's what I have today:
> 
> Hypercalcemia secondary to malignancy, history of renal cell cancer, status post nephrectomy in 2008 and recently was found to have pulmonary metases.
> 
> Can someone help me break this one down? I think I am just getting overwhelmed by this one, and the rest of the note is huge also any help is appreciated!



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Following is the excerpt obtained from* CMS LCD policy* for management of *hypercalcemia "associated with malignancy".* 
*ICD-9 Code that Support Medical Necessity*/coverage criteria.

For HCPCS code J1457:
*275.42* 	Hypercalcemia *covered when due to malignancy only*

{Gallium nitrate (J1457) is covered for the treatment of *symptomatic cancer-related hypercalcemia (ICD-9 275.42)*. In general, patients with serum calcium (corrected for albumin) less than 12 mg/dl would not be expected to be symptomatic.
The recommended usage for gallium nitrate is daily for five consecutive days. Use for more that 5 days will be denied as not medically necessary.
More than one course of treatment for the same episode of hypercalcemia will be denied as not medically necessary.}

Thanks


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