Oncology & Hematology Coding Alert

Hint: You may need to flip to the V code section of the manual

Did you ever tell someone you work at an oncology office only to have her list every brush with cancer her family ever had? Put the experience to good use by testing your diagnosis coding skills. We-ve put together a story for you -- fill in the blanks with the appropriate ICD-9 codes.  Then check your answers below to see if you choose the correct codes. 

My family medical history includes a lot of cancer diagnoses. My mom spent years baking in the sun, and last summer her physician treated her for squamous cell carcinoma on her back (1. ___).

Her mom had uterine cancer. Apparently, there were so many overlapping tumors they couldn't really tell where it started (2. ___).

Her father had several cancers, including non-Hodgkins lymphoma centered in his head and neck (3. ___), probably because he was part of the atomic bomb tests conducted by the military in the 1950s.

He used to joke that he wasn't worried if he had to have an encounter for chemotherapy (4. ___) because he had already lost his hair.

His brother had pancreatic cancer that started in the head of the pancreas (5. ___). It was pretty advanced when they found it. It had already spread to his liver (6. ___).

At one point, my mom felt a lump (7. ___) in the bottom-inside part of her breast and was afraid the doctor would diagnose her with breast cancer (8. ___). Fortunately, I don't have to say I have a personal history of breast cancer (9. ___) or family history of breast cancer (10. ___).

I worry about my dad because I think his mom had cancer, too. She had a mass in her lungs (11. ___). The family decided not to have it biopsied because she was already so sick.

We finally talked my dad into having a colonoscopy, and he had a clean bill of health. I don't even have to say I have a family history of colon polyps (12. ___).

How did you do? Find out below.
 
1. 173.5 (Other malignant neoplasm of skin; skin of trunk, except scrotum)

A note with the code in the ICD-9 manual tells you this code includes skin of the back.

Remember that if the physician documents the carcinoma as in situ, you should instead report carcinoma in situ code 232.5 (Carcinoma in situ of skin; skin of trunk, except scrotum).

2. 182.8 (Malignant neoplasm of body of uterus; other specified sites of body of uterus)

A note with this code tells you the code is appropriate for -malignant neoplasm of contiguous or overlapping sites of body of uterus whose point of origin cannot be determined.-

Tip: The cervix is part of the uterus, says coding consultant Melanie Witt, RN, CPC-OGS, MA, in her audioconference, -Tackle Tough Gynecological-Oncology Coding,- for The Coding Institute. But diagnosis codes differ based on whether the neoplasm is in the cervix or in the body of the uterus, so be sure you verify the location before you choose your code.

3. 202.81 (Other lymphomas; lymph nodes of head, face, and neck)

Pay attention: This code requires a fifth digit to designate the affected lymph node sites.

4. V58.11 (Encounter for anti-neoplastic chemotherapy)

According to ICD-9 guidelines, you should use this V code as the primary diagnosis code when the patient presents only for chemotherapy.

5. 157.0 (Malignant neoplasm of pancreas; head of pancreas)

6. 197.7 (Secondary malignant neoplasm of respiratory and digestive systems; liver, specified as secondary)

Rule: When a patient presents for treatment directed only at the secondary malignancy, designate the secondary neoplasm, not the primary one, as the primary diagnosis, according to ICD-9 Official Guidelines.

7. 611.72 (Signs and symptoms in breast; lump or mass in breast)

8. 174.3 (Malignant neoplasm of female breast; lower-inner quadrant)

9. V10.3 (Personal history of malignant neoplasm; breast)

10. V16.3 (Family history of malignant neoplasm; breast)

11. 786.6 (Swelling, mass, or lump in chest)

12. V18.51 (Family history of colonic polyps)

Don't miss: Code V18.51 is new for 2007. You haven't had a good way to describe this in the past, so this new V code is a great help, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, coding manager for the University of Washington's physician group in Seattle.