Gastroenterology Coding Alert

Uncover how a pathology report can save your claim.

Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it's regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice's deserved dollars with these 3 tips.

1. Don't Go Looking For 'Benign', 'Malignant'

Whether or not you're dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these include:

• Adenomas including tubular adenomas and tubulovillous adenomas
• Hyperplastic polyps
• Inflammatory polyps
• Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If this is left untreated, the patient becomes high risk to develop colon cancer.
• Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer.

But first, you have to accomplish the task of determining -- without a doubt -- if a polyp is benign or malignant. If you think you would find the clues in the pathology report (PR), think again. Usually, the PR will not use the term "benign" or "malignant." However, it will use a description that points to the usual behavior of the polyp. It's up to you to interpret those descriptions into benign or malignant.

Important: Experts advise that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves, usually defer to the pathology report before making a recommendation.

2. Consult ICD-9 Neoplasm Table

The ICD-9 Alphabetic Index to Diseases (Volume 2) features a neoplasm table where you can select a definitive diagnosis code for a polyp. All diagnosis codes for neoplastic polyps -- and some non-neoplastic polyps -- will come from this table. So as not to get overwhelmed with the huge amount of information in the table, consider just three things when choosing the right polyp code:

a) Body part. For malignant primary neoplastic polyps in the colon, you should look for the specific site of the colon which the physician should mention in the procedure report (i.e., traverse, sigmoid, ascending, and descending).

For all other behaviors, the code descriptions make a general reference to the colon, large intestine or digestive system.

b) Behavior. Specifically, behavior refers to the polyp's capacity to spread. If the polyp is benign, it is noncancerous; if it's malignant, it is cancerous. A polyp can also be defined as 'uncertain' (235.2, Neoplasm of uncertain behavior of stomach, intestines and rectum) if its behavior is unpredictable and needs further investigation. On the other hand, an unspecified polyp (239.0, Neoplasm of unspecified nature of digestive system) needs to be determined further by lab tests.

c) Malignant polyp's nature. You would further classify a malignant polyp into primary, secondary or in situ. A primary malignant colonic polyp (153.0-154.0) is one where the colon is the original site of the cancer. Secondary (197.5, Secondary malignant neoplasm of large intestine and rectum) means the cancer has metastasized from another site to the colon. An in situ malignant colonic polyp (230.3-230.4) is one where the cancer is confined to the colon.

Extra: If you have a hard time determining the primary site of a cancer because it has already spread to neighboring tissue, you could use 153.8 (Malignant neoplasm of other specified sites of large intestine). This includes malignant neoplasm of contiguous or overlapping sites of the colon whose point of origin cannot be determined.

If the rectum is included with the colon cancer, then assign code 154.0 (Malignant neoplasm of rectosigmoid junction).