Oncology & Hematology Coding Alert

Lung cancer is one of the most expensive to treat, so be sure you know when to apply V66.7

With the recent death of Peter Jennings and the diagnosis of Christopher Reeve's widow, Dana, lung cancer awareness is on the rise-meaning it's time to heighten your awareness of how to code your oncologist's treatment of this disease.

The American Cancer Society estimates that in 2005, 172,570 people will be diagnosed with lung cancer and 163,510 people will die from it. Impact on coding: Many oncologists prescribe palliative therapy for lung cancer patients because so many present with an advanced stage of the disease.

Know the term: -Palliative treatment is used to help the patient feel better and achieve better quality of life,- says Alice Ettinger, MSN, RN, APN-C, an oncological nurse with Saint Peter's University Hospital in New Brunswick, N.J.

For lung cancer patients, palliative therapy -can involve the use of radiation therapy, chemotherapy, and other medicine,- says Linda Gledhill, MHA, senior associate with oncology consulting firm ELM Services Inc., based in Rockville, Md. Oncologists may choose palliative care in stage-III and stage-IV lung cancer patients when the cancer is unresectible or has spread to other organ systems, she adds.

Delete Diagnosis Dilemmas

Scenario: A patient presents with a primary malignant neoplasm on the middle lobe and a secondary neoplasm on the occipital lobe. Your documentation for one date of service shows the patient arrived for external beam radiation therapy directed solely at the lung tumor. The oncologist documents that the treatment is palliative, to help alleviate trouble breathing caused by the lung tumor.
 
Problem: You have to decide which neoplasms to report with diagnosis codes and whether you should include any secondary codes.

Solution: You should report the underlying disease before reporting palliative care,  Gledhill says. Doing so puts you in line with American Hospital Association guidance.

If you treat only the primary malignancy, you typically report that malignancy as the principal diagnosis, says Marlice Cooper, RHIT, CPC, an oncology-coding specialist with H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla.

Example: For a primary lung malignancy, look to the 162.x range, Gledhill says. In the scenario above, report 162.4 (Malignant neoplasm of trachea, bronchus, and lung; middle lobe, bronchus, or lung). Smart: Report the secondary malignancy, as well, to indicate the extent of the disease process.

Tip: If the oncologist treats only the secondary site, report the secondary neoplasm as the principal diagnosis, Cooper adds, in agreement with the official ICD-9 guidelines, available at www.cdc.gov/nchs/data/icd9/icdguide.pdf. Note: These guidelines also tell you that if the patient presents solely for chemotherapy or radiation therapy, you should report V58.1 (Encounter for chemotherapy) or V58.0 (Encounter for radiotherapy) as your principal diagnosis. Check your payer guidance to confirm the order for your diagnosis codes.

Next: After you report the underlying disease, you should indicate that the oncologist chose the service for palliative care and report the symptom he treated, Gledhill says.

Example: You report the lung cancer and then code V66.7 (Encounter for palliative care) and any documented symptoms, Gledhill says. A common symptom is 786.05 (Shortness of breath).

Helpful: Code V66.7 has the symbol -SDx- next to it in your ICD-9 manual. This symbol means that you should only report V66.7 as a secondary diagnosis and never as a primary diagnosis. Benefit: Your practice can run reports to quantify the number of palliative patients you treat and what conditions they have.