Oncology & Hematology Coding Alert

Wait for the pathology report and carefully review ICD-9 tables for claims success If you-re occasionally overwhelmed trying to find an appropriate neoplasm diagnosis, take heart: With the pathology report, a current ICD-9 manual and our expert advice at hand, you can nail the appropriate code without fail. Step 1: Don't Make a Move Without the Path Report You shouldn't even try to choose a neoplasm diagnosis until you-ve received the results of the pathology study, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians and Children's University Medical Group Compliance Program. "Without the pathology report, you-re just guessing what kind of neoplasm you-re dealing with," she adds. And entering a wrong diagnosis can have serious effects. You don't want to label a patient as having cancer if the diagnosis isn't certain. A cancer diagnosis is a red flag for insurers that could make gaining medical coverage more difficult for the patient. At the same time, if you fail to indicate a malignant lesion (when present), you limit the treatment options that the insurer may accept at a later date. Bottom line: Choosing a diagnosis is hard enough, so be sure you have all the relevant information before you proceed.  
Step 2: Identify Neoplasm Type With the pathology report in hand, you should be able to determine if the neoplasm is benign or malignant. The neoplasm table in ICD-9-CM further classifies malignant and benign neoplasms into various subclassifications, as follows: Primary: A primary malignancy arises from the stated or presumed site or origin, Bucknam says. For example, if a female patient has a malignant breast lump that originates in the lower-inner quadrant (as opposed to cancer cells that originated elsewhere and spread to the breast), you should code for a primary malignancy (174.3, Malignant neoplasm of female breast; lower-inner quadrant). Secondary: Use these codes when the neoplasm is the result of metastasis and forms a new focus of malignancy elsewhere -- such as the lymph nodes, liver, lungs or brain -- or when the primary cancer has invaded adjacent structures (direct extension). For example, if pathology indicates that a lump from the chest wall beneath a previous mastectomy is a secondary malignancy of a lymph node, you would report 196.3 (Secondary and unspecified malignant neoplasms of lymph nodes; lymph nodes of axilla and upper limb). Warning: You should not report a "recurrence" of the same cancer as a secondary malignancy. In situ: "In situ" describes malignancies confined to their site of origin. Although such neoplasms have not yet invaded neighboring tissues, they can grow large enough to cause major problems, and may become invasive. Tip: "In situ" is a histopathological [...]