Assigning the Proper ICD-9 Codes Optimizes Payment for Breast and Genitourinary Cancers
Published on Mon May 01, 2000
"When coding for the diagnosis of breast or genitourinary cancers, ICD-9 offers only a few optionsthere are essentially three sets of codes from which to choose. Sounds pretty simple, but understanding the definitions of these types of cancer and the intent of the code is another story.
At the recent CodingFest 2000 coding conference in Florida, Stephanie L. Jones, NRCMA, NRCAHA, CPC, an independent coding consultant, presented a workshop on cancer coding. A lively debate ensued over which codes to assign for which kinds of cancer tumors. The gist of the dilemma dealt with the three main categories of ICD-9 codes for cancer tumors. Some members of the audience were adamant that a cancer tumor, no matter how small or how large, if confined to the organ where it originated, was always coded carcinoma in situ. In their view, primary carcinoma is to be used only when a secondary carcinomai.e., a metastasis to another organ other than the organ of originis also present. Their contention was that a primary code could never be used if there was not also a secondary cancer code reported on the claim form.
In contrast, about half of the audience said their clinics coded a single tumor confined to the organ of origin as primary whether or not there was a secondary carcinoma, i.e., a metastasis to another organ. They also felt that carcinoma in situ was much more narrowly defined in the medical dictionary as a tiny spot of cancer that had not broken through its surrounding tissue. Thus there is a breast biopsy diagnosis for ductal carcinoma in situ, which can mean just watchful waiting or a lumpectomy for the patient, rather than a radical mastectomy as might be the case with an invasive, primary or secondary breast cancer.
Numerous coders stated they were aware of the term carcinoma in situ, perhaps most popularly associated with ductal carcinoma in situ for mammograms with follow-up biopsies, and cervical carcinoma in situ for Pap smears with cervical biopsies. But, they felt the term was usually reserved for small, pre-invasive lesions not qualifying as full-fledged primary neoplasms. The level of disagreement and confusion over the subject was strong enough to motivate Ob-Gyn Coding Alert and Jones to review the rules and definitions for cancer coding for ob/gyn.
Understanding and Coding Stages of Neoplasms
Because of the controversy surrounding this topic, says Jones, I wanted to fill in the details and figure out which school of thought was corrector closest to being correct. I wanted to get clarification from a bonafide source, so I went to the World Health Organization, which [...]
