Oncology & Hematology Coding Alert

You need to pay special attention to this V code rule You can cut out a good chunk of time-consuming appeals - and boost your accuracy rate - if you apply a few diagnosis coding fundamentals up-front.

Get started: Follow these expert recommendations to ensure you-re properly coding patients- signs, symptoms and diagnoses.   1. Block Denials Using All Possible Digits

Correct coding requires that you code as specifically as possible. That means you should assign the most precise ICD-9 code to a service.

How to do it: Use the fourth or fifth digit when ICD-9 requires it, says Karen Marsh, RN, MSN, president of Kare-Med Consulting in Jensen Beach, Fla. Make sure you review the entire record when determining the specific reasons for the encounter and the conditions the physician treated, she says.

You cannot justify a service with a four-digit diagnosis code when carriers or ICD-9 requires a more specific five-digit code to describe the patient's condition.

Example: If you are coding for cervical cancer, you cannot simply report 180 (Malignant neoplasm of cervix uteri) because three digits alone don't make a complete diagnosis. ICD-9 offers four-digit options, which you must use instead, such as 180.0 (- endocervix).

Pitfall: Don't assume what isn't in the medical record. If the medical record does not offer the information (such as anatomic region) that you need to choose the most specific code, check with the reporting physician for guidance. If the physician doesn't supply the information you need, choose an -unspecified- code, such as 180.9   (... cervix uteri, unspecified), rather than reporting 180 without a fourth digit or randomly choosing another fourth digit.

Watch out: Coding -cheat sheets- often don't list fifth digits, so you should always check your code choice in the ICD-9 manual. You also don't want to rely on unspecified codes too often. Payers believe that if a doctor treats a lesion with radiation or chemotherapy, he-d better know - and document - exactly where it is.

Bottom line: Payers are sure to reject claims that use truncated ICD-9 codes (shortened by dropping one or more digits after the decimal point). Nip denials in the bud by accurately reporting all possible digits. 2. Stop Skipping Over Signs and Symptoms

When your oncologist provides a confirmed diagnosis, you should always code that diagnosis instead of the presenting signs and symptoms. But if the oncologist can't document a definitive diagnosis, report the patient's signs and symptoms to support medical necessity for services the physician provides.

Key point: Payers use [...]