Oncology & Hematology Coding Alert

Get your coding up to snuff during October, National Breast Cancer Awareness Month

Quick quiz: Do you know what the term -midline- refers to in breast cancer diagnosis coding? What about -axillary tail-? One misstep could spell trouble from your payer, but we-ve got three tips that will keep your coding in top shape.

Tip 1: Determine the Reason for Tamoxifen

Oncologists debate whether Tamoxifen (Novadex) is for breast cancer treatment or prevention, says Kim Garner Huey, CPC, CCS-P, CHCC, an independent coding and reimbursement consultant in her audioconference for The Coding Institute, -Nine Proven Solutions Guarantee Breast Surgery Pay-Up.-

If the oncologist documents that the medication is for treatment, report the appropriate code for malignant neoplasm of breast (such as 174.0, Malignant neoplasm of female breast; nipple and areola). If the oncologist instead says the patient's therapy is complete and the medication is for prevention, report V10.3 (Personal history of malignant neoplasm; breast).

Note: The American College of Obstetricians and Gynecologists asked the ICD-9 Committee to add a code for estrogen receptor status to be used with breast malignant neoplasm codes (www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/agendasept05.pdf, page 54). Check your 2007 manual to see whether you need to add these to your coding selections for services on or after Oct. 1.

Tip 2: Don't Overuse 174.9

You report 174.9 (Malignant neoplasm of female breast; breast [female], unspecified) when your documentation doesn't give the breast neoplasm's location--but somebody knows where the tumor is, Garner says. Let the physician know to be specific so you don't have to rely on the unspecified code.

If you can't get the specifics and are left with no specified site, don't report 174.8 (Malignant neoplasm of female breast; other specified sites of female breast) because you think it looks better than 174.9, Garner says. You have to choose the code that matches the documentation.

Heads up: ICD-10 won't have these unspecified codes to fall back on, so start easing your physicians into documenting neoplasm location, Garner says.

Tip 3: Keep Tabs on Codes and Terms

You need to study up on terminology to keep your breast neoplasm coding accurate.

Two important terms you need to keep in mind are the following, says Cindy Parman, CPC, CPC-H, RCC, president of the American Academy of Professional Coders National Advisory Board and co-owner of Coding Strategies Inc. in Powder Springs, Ga.:

- midaxillary line--an imaginary vertical line passing through the middle of the axilla

- midclavicular line--an imaginary vertical line passing through the midshaft of the clavicle.
 
Keep This Handy Reminder

You can use the chart on the previous page to remind yourself of more malignant breast neoplasms terms and codes. Example: To understand the location of the central portion of the breast (see 174.1), -picture the breast with two parallel lines drawn vertically--one third is outer, one third is central, and one third is inner,- Parman says.