Oncology & Hematology Coding Alert

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below.

Answer 1: According to ICD-10-CM guideline I.C.21.c.8, follow-up care consists of “continuing surveillance following completed treatment of a disease, condition, or injury.” It implies “the condition has been fully treated and no longer exists.”

In other words, the key to defining follow-up care as far as ICD-10-CM coding is concerned is to verify that:

• The condition no longer exists.
• There is no ongoing treatment for the condition.

Aftercare, on the other hand, 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,” according to ICD-10-CM guideline I.C.21.c.7. Guideline I.C.21.c.8 clarifies that aftercare “explain[s] ongoing care of a healing condition or its sequelae.”

In other words, unlike follow-up, aftercare implies that the condition is in the healing or sequela phase, and that any treatment is directed to that phase of the illness, not the original condition itself. In other words, “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.

Answer 2: 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.” 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.

For example, suppose 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).

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.

Answer 3: To code aftercare following radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm, the aftercare guideline I.C.21.c.7 tells 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 aftercare guideline also 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.”

So, for a patient receiving palliative chemotherapy for primary liver cancer, 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.

Answer 4: Coding for aftercare following a surgical procedure for cancer is different from coding aftercare following antineoplastic therapy. Per ICD-10-CM guideline I.C.21.c.7, you will use the code for the surgical procedure, such as Z42.1 (Encounter for breast reconstruction following mastectomy) and Z48.3 (Aftercare following surgery for neoplasm).

Remember: Just be sure to follow the Excludes1 and Use additional code instructions associated with Z48.3, which tell you to use follow-up code Z08 if that more appropriately describes the circumstances of the encounter and to use an additional code to identify the neoplasm.

So, if 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.