Oncology & Hematology Coding Alert

You Be the Coder:

Coding for an Elevated CA-125

Published on Fri Jun 01, 2001

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: What is the correct way to code for an elevated CA-125? We have a patient who is being observed by the doctor for an elevated CA-125, but no other treatment is being done and the physicians dictation simply states her diagnosis as elevated CA-125. We have coded her visits as 796.4 (other abnormal clinical findings).

Oklahoma Subscriber

Answer: Code 796.4 is not correct, but the phrase elevated CA-125 is correct. CA-125 is an antibody found associated with the presence of tumor cells. Its level is assessed in the laboratory as a sample of the patients blood.

The correct code is 790.99 (other nonspecific findings on examination of blood), because it best describes the situation a blood test result without a specific known condition. If there is a specific condition stated in the medical record, remember to code that condition. For example, codes 251.2 (hypoglycemia), 276.7 (hyperkalemia), and 272.4 (hyperlipidemia) often accompany an elevated CA-125. An elevated CA-125 is often an indication of ovarian cancer (183.0).

Loading....

Other Articles in this issue of
Oncology & Hematology Coding Alert
Determine When To Use Prolonged Service Codes for Extra Time
When an oncology-related visit takes longer than normal, codes +99354-+99355 used to describe a prolonged [...]
Reimbursement for Simulations Depends on Careful Documentation and Medical Necessity
The key to getting paid for simulations in radiation oncology no matter how many are [...]
You Be the Coder:
Coding for an Elevated CA-125
Test your coding knowledge. Determine how you would code this situation before looking at the [...]
Use Code 36540 for Blood Collection but Not Port Flushes
When CPT 2001 included a new code for blood collection from ports, 36540 (collection of [...]
News Flash:
New Drug, No Code
The FDA has approved a new anti-cancer drug for patients with chronic myeloid leukemia (CML), [...]
Reader Question:
Use Code 77370 Correctly
Question: Can more than one special medical physics consult, 77370 (special medical radiation physics consultation) [...]
Reader Question:
Billing for Activase
Question: How should we bill 2 mg of Activase when the HCPCS code (and Medicare [...]
Reader Question:
Coding for CT Scans Without Medical Necessity
Question: I am having problems getting reimbursed for a CT scan of the brain without [...]
Reader Question:
Two Physicians
Question: When can two different physicians (in the same practice) bill for an inpatient visit [...]
View All