Oncology & Hematology Coding Alert

Question:  In a patient diagnosed with prostate cancer two years ago, our physician did a repeat biopsy as the PSA levels went up again. Two years ago, this patient tested positive on biopsy with an adenocarcinoma in one of the five cores. The patient, who then declined surgery, had a repeat prostate biopsy but this time tested negative in all cores on biopsy. Is it likely that Medicare questions the repeat biopsy? How can we report this diagnosis?

Pennsylvania Subscriber

Answer:  The diagnosis reported should be the condition confirmed by the physician in the supporting documentation.  If the reason for the biopsy was documented to verify the status of the malignancy previously found, you would report diagnosis code 185 (Malignant neoplasm of prostate) for the prostate biopsy.  If the physician indicated the second biopsy was done because the patient has a history of prostate malignancy, then V10.46 (Personal history of malignant neoplasm of prostate) would be more appropriate. In ICD-10-CM, you will consider codes C61 (Malignant neoplasm of prostate) and Z85.46 (Personal history of malignant neoplasm of prostate).

Should there be a question regarding which code to assign because the physician’s documentation isn’t clear or definitive, the physician should be queried for clarification to choose the right ICD-9-CM or ICD-10-CM code for the situation on the date of service.