Oncology & Hematology Coding Alert

Question: We have a patient with small cell lung cancer. The oncologist has ordered radiation directed at the brain even though the patient has an MRI indicating no metastasis to the brain. Which diagnosis code should I report for the brain radiation?

Florida Subscriber

Answer: The radiation you describe is prophylactic (preventative) in nature, so you should indicate this by reporting V07.8 (Other specified prophylactic measure).

Additional codes: ICD-9 official guidelines state that "if a patient admission/encounter is solely for the administration of ... radiation therapy assign code V58.0, Encounter for radiation therapy, ... as the first-listed or principal diagnosis" (www.cdc.gov/nchs/data/icd9/icdguide10.pdf).

You also should report the diagnosis of primary small cell lung cancer, based on location (162.x, Malignant neoplasm of trachea, bronchus, and lung).

Reality: Reimbursement from an insurer for prophylactic radiation may be a problem because you are not treating an identified malignancy.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Kelly C. Loya, CPC-I, CPhT, senior consultant with Sinaiko Healthcare Consulting Inc.