Oncology & Hematology Coding Alert

When your physician documents the patient presented for the administration of chemotherapy, submit code V58.11 (Encounter for antineoplastic chemotherapy) as the primary ICD-9-CM code on the claim. Additionally the physician’s documentation here clearly states the patient has a stage IIA non-small cell lung cancer. Since the physician hasn’t provided any further details of the primary lung cancer, you can best report this with code 162.9 (Malignant neoplasm of bronchus and lung unspecified). Further, your physician has documented the primary in the lung has metastasized to the bone. For the secondary malignancy in the bone, you report code 198.5 (Secondary malignant neoplasm of bone and bone marrow). 

Link medication to appropriate diagnosis: You may encounter situations where your physician will treat both the primary malignancy as well as the metastasis. In this case, you should make an attempt to determine and differentiate the treatments targeting the two and link to appropriate diagnosis. “It is best practice to check with each carrier and verify their coding policies,” says Elizabeth Wernet, CPC, CHONC, Certified Coding Specialist, Healthcare Management Resources, Inc. in Eagan, MN. “The best resource for this is the National Coverage Determinations on the CMS website. Most payers will follow this NCD.”