Oncology & Hematology Coding Alert

In tip 3, find out why 233.2 claims demand a second look Uterine cancer is the most common type of gynecologic cancer, so one bad ICD-9 habit could sink a large number of your claims. There's no better time to hone your diagnosis coding know-how than September -- Gynecologic Cancer Awareness Month. These five tips get you on your way. 1. Pay Attention to Digits for Primary Neoplasm About 90 percent of uterine cancer begins in the lining, says coding consultant Melanie Witt, RN, CPC-OGS, MA, in her Coding Institute audioconference, -Tackle Tough Gyn Oncology Coding.-

This lining is also called the endometrium, and a primary neoplasm of the endometrium merits 182.0 (Malignant neoplasm of body of uterus; corpus uteri, except isthmus), according to the ICD-9 manual's neoplasm table.

You should always check the index entry in the ICD-9 tabular list to be sure you report the most accurate code. Flip to 182 (Malignant neoplasm of body of uterus) in the tabular list, and you see an instruction to --4th- -- meaning that you should report a code with a fourth digit instead of reporting the three-digit 182. Your options are 182.0, 182.1 (- isthmus), and 182.8 (... other specified sites of body of uterus).

The tabular list verifies that 182.0 is the appropriate code: A note with 182.0 says the code describes primary malignant neoplasms of the endometrium, as well as the cornu, fundus, and myometrium. This list is made of -inclusion terms- according to the official ICD-9 guidelines (www.cdc.gov/nchs/data/icd9/icdguide.pdf). Inclusion terms may be synonyms for the code title or conditions assigned to an -other specified- code.

Tip: Inclusion terms aren't exhaustive, so if a term in the index directs you to a code, but you don't see the term in the inclusion list, the code may still be correct.

Heads up: The ICD-9 manual offers different codes for various parts of the uterus, so take time to check the code for the specific neoplasm site. For example, you should report 180.x (Malignant neoplasm of cervix uteri) for a primary malignant neoplasm of the cervix.

When the documentation isn't clear about where the neoplasm is located in the uterus, you should look beyond the 182 codes.

In this case, report 179 (Malignant neoplasm of uterus, part unspecified), Witt says.

2. Seek Out the Proper Secondary Code In some cases, the uterine neoplasm is the result of a primary neoplasm in another part of the body metastasizing. In this case you should report a secondary neoplasm code.

For uterine cancer, the secondary neoplasm code is 198.82 (Secondary malignant neoplasm of other specified sites; genital organs), Witt says.

Tip: Next to code 198.8 (... other specified sites) the ICD-9 manual includes a note to -5th.- [...]