Oncology & Hematology Coding Alert

Here are some useful tidbits from "ICD-9-CM Official Guidelines for Coding and Reporting" produced by The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS).

Section I.C.2.b -- Treatment of secondary site: When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.

Section I.C.2.d -- Primary malignancy previously excised -- When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy, a code from category V10 (Personal history of malignant neoplasm) should be used to indicate the former site of the malignancy. Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed with the V10 code used as a secondary code.

Section 1.C.2.e -- Patient admission/encounter solely for administration of chemotherapy, immunotherapy, and radiation therapy: If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or radiation therapy assign code V58.0 (Encounter for radiation therapy), or V58.11 (Encounter for antineoplastic chemotherapy), or V58.12 (Encounter for antineoplastic immunotherapy) as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence.

And note this new instruction for 2009:

Section 1.C.2.i -- Malignant neoplasm associated with transplanted organ: A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign first the appropriate code from subcategory 996.8 (Complications of transplanted organ), followed by code 199.2 (Malignant neoplasm associated with transplanted organ). Use an additional code for the specific malignancy.

Resource: Find the official guidelines online at http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf.