Oncology & Hematology Coding Alert

Caution:  Don't base your diagnosis code on demonstration-project eligibility

Good news: CMS added gynecologic oncologists to the list of providers eligible to participate in this year's oncology demonstration project. But it's up to you to prove that your patient is eligible for coverage, which means getting your ovarian cancer diagnosis coding up to snuff.

The project: You have the option of using -G- codes to report compliance with various standards of care for various cancers--including ovarian cancer. (See the February and March issues of Oncology Coding Alert for more details.) At first, CMS didn't realize that gyn-oncs treat ovarian cancer, and left them off the list of specialties that could participate in the demonstration.

After a lot of lobbying by the Society for Gynecologic Oncology, CMS finally realized its mistake and added gyn-oncs to the list in Change Request 4347, dated March 3.

Opportunity: CMS made the change retroactive to January, so your gyn-onc can resubmit denied claims for those -G- codes and receive payment, says Gary Leiserowitz, MD, professor and chief of the division of gynecologic oncology at UC Davis Medical Center.

Brush Up on Ovarian Cancer ICD-9 Coding

Ovarian cancer patients are only eligible for the demonstration project if they have a primary cancer diagnosis of 183.0 (Malignant neoplasm of ovary and other uterine adnexa; ovary).
 
Code 183.0 is the only primary ovarian cancer code, says coding consultant Melanie Witt, RN, CPC-OGS, MA, in her presentation for The Coding Institute, -Tackle Tough Gyn Oncology Coding.- You may determine you need this code for a number of carcinomas, including micropapillary, serous, mucinous, endometroid, squamous, and clear cell, she says.

Remember: Don't choose your diagnosis code based on what will make your patient eligible for the study. Choose the code based on the oncologist's documentation.

Example: If your documentation states that the ovarian cancer is secondary to another cancer, your patient would merit secondary ovarian cancer code 198.6 (Secondary malignant neoplasm of other specified sites; ovary), Witt says.

Borderline lesions: You won't just see primary and secondary ovarian cancer. You may also see borderline tumors, but watch out. Your physician may start referring to -borderline- or -low malignant potential- lesions as -atypical proliferative tumors,- Witt says.

If your oncologist only uses one of these terms to describe the tumor, check for more details before you code. A borderline tumor with no invasion may merit 236.2 (Neoplasm of uncertain behavior of genitourinary organs; ovary) or 220 (Benign neoplasm of ovary), Witt says.

A borderline lesion with invasive implants is more accurately described by 233.3 (Carcinoma in situ of breast and genitourinary system; other and unspecified female genital organs), she says.

Caution: Think twice before you report 239.5 (Neoplasms of unspecified nature; other genitourinary organs). You should base your decision to report this code on specific documentation from the pathologist--don't use this code just because you think the physician's documentation isn't specific, Witt says.

If the physician's documentation isn't specific and your only legitimate option is to report 183.8 (Malignant neoplasm of ovary and other uterine adnexa; other specified sites of uterine adnexa) or 183.9 (... uterine adnexa, unspecified) for a malignant neoplasm or 625.8 (Other specified symptoms associated with female genital organs) for documentation of an -ovarian mass,- check with your physician. More details could help you choose a more specific code.

Fulfill the -Follow-Up- Task

ICD-9 guidelines instruct you to report a -history of- code (such as V10.43, Personal history of malignant neoplasm; genital organs; ovary) once the patient has completed all treatment, Witt says. You may use signs and symptoms codes (such as 789.0x, Abdominal pain) in addition to the personal history code. But check with each payer regarding its follow-up protocols, because they do vary, Witt says.