ICD 10 Coding Alert

Boost your oncology coding by distinguishing the types of care a patient may receive during or after treatment.

Coders who work with oncology practices encounter situations where they need to code aftercare — and they need to be able to distinguish aftercare from follow-up, monitoring, or surveillance. Lean on the ICD-10-CM guidelines for oncology to ensure that your reporting is accurate.

Consider these three scenarios, as well as a deep dive into follow-up and aftercare Excludes1 instructions.

Understand How Aftercare is Different Than Follow-Up Care

ICD-10-CM guideline I.C.21.c.7 tells you aftercare begins “when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease.” It also tells you not to document aftercare “if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases.”

However, the guideline notes an important exception to this rule for antineoplastic therapy, as we will see later.

Follow-up care, on the other hand, consists of “continuing surveillance following completed treatment of a disease, condition, or injury.” It implies “that the condition has been fully treated and no longer exists,” according to guideline I.C.21.c.8.

Hot tip: “Timing and specificity are the key terms that will help you understand the difference between follow-up and aftercare,” says Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC.

ICD-10-CM does not define two other, similar terms — surveillance and monitoring — but from a coding perspective, you can regard both terms as synonyms. And, as you’ll see below, “surveillance” is an inclusion term for follow-up.

Know These Follow-Up Codes

Per guideline I.C.21.c.8, you’ll look to Z08 (Encounter for follow-up examination after completed treatment for malignant neoplasm) once a provider determines a patient’s course of treatment has ended and the care plan has moved into the medical surveillance phase. This code carries with it a Use additional code instruction telling you to use a code from Z85.- (Personal history of malignant neoplasm) in addition to Z08.

Or, to put it another way, you’ll use Z08 “for all follow-up visits when the patient has finished their treatment plan, including any type of medication, regardless of who put the patient on the medication.” The guideline also tells you to “sequence the code first and then use a secondary code for a history of a disease,” instructs Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Include this term: Z08 contains “medical surveillance following completed treatment” as an inclusive term.

Important exception: If, on one of the follow-up visits, the provider finds the condition has returned, you should not use Z08. Instead, ICD-10-CM guideline I.C.21.c.8 tells you to use the code for the condition and not the follow-up Z code.

Scenario 1: A patient returns to your office two years after completing treatment for endometrial cancer. The provider finds that the condition is still in remission, so you’ll code Z08 first, followed by Z85.42 (Personal history of malignant neoplasm of other parts of uterus).

Note the Antineoplastic Therapy Aftercare Exception

The aftercare rule guidelines go on to tell you to use Z51.0 (Encounter for antineoplastic radiation therapy) and codes from Z51.1- (Encounter for antineoplastic chemotherapy and immunotherapy) “when a patient’s encounter is solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm.”

Sequencing: The guideline tells you that “aftercare codes should be used in conjunction with other aftercare codes or diagnosis codes to provide better detail on the specifics of an aftercare encounter visit, unless otherwise directed by the classification.” The guideline also notes that the aftercare codes “are to be first listed, followed by the diagnosis code when a patient’s encounter is solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm.”

Scenario 2: A patient receives palliative chemotherapy for primary liver cancer. You’ll use Z51.11 (Encounter for antineoplastic chemotherapy) as the first-listed code with a code such as C22.8 (Malignant neoplasm of liver, primary, unspecified as to type) for the diagnosis. And as the example indicates it is palliative care, you may also add Z51.5 (Encounter for palliative care), which should be listed as the second or third diagnosis code.

Remember: You can use more than one code from the Z51.0 and Z51.1- categories if the patient receives more than one kind of antineoplastic therapy.

Don’t Forget the Other Oncology Aftercare Code

In addition to the Z51.0 and Z51.1- codes, ICD-10-CM guideline I.C.21.c.7 identifies a number of other codes applicable to oncology coding. They include aftercare codes you will use following a surgical procedure, such as Z42.1 (Encounter for breast reconstruction following mastectomy) and Z48.3 (Aftercare following surgery for neoplasm). A number of instructions follow Z48.3, including the Excludes1 note discussed later and a note to Use additional code to identify the neoplasm involved in the surgery.

Scenario 3: A patient successfully undergoes surgery for removal of a brain neoplasm and visits the oncologist for evaluation of the wound and neurological deficits. In addition to using Z48.3, you’ll use a code such as C71.1 (Malignant neoplasm of frontal lobe) per the Use additional code instruction.

Don’t Forget These Excludes1 Rules

To reinforce the difference between these terms, there are a number of Excludes1 instructions that you will need to follow for accurate and compliant documentation:

• Z08:    Excludes1 aftercare following medical care (Z43-Z49, Z51)
• Z48.3: Excludes1 encounter for follow-up examination after completed treatment (Z08-Z09)
• Z51.-:  Excludes1 follow-up examination after treatment (Z08-Z09).