Oncology & Hematology Coding Alert

Answer: Handle the diagnosis coding issues like this: Treatment to the lung for lung cancer will be assigned a diagnosis code from category 162, with a fourth digit that specifies the location in the lung, 162.0-162.9. It is essential that the diagnosis be coded to the highest degree of specificity, or to the exact location within the lung that is being treated.

Prophylactic treatment may be a problem from a reimbursement standpoint. In general, payers provide payment for the treatment of malignancies with radiation therapy. Malignancy is defined as behaving in a life-threatening manner, which includes diagnoses in addition to cancer but does not necessarily include prophylactic treatment. The concern with coding this as brain cancer is that you are assigning the patient a secondary malignancy assuming that the brain cancer was coded as secondary to the lung cancer where no cancer has been diagnosed at the time of treatment.

Although a specific ICD-9 code exists for prophylactic chemotherapy (V07.31, prophylactic fluoride administration), the code for prophylactic radiation therapy would be assigned to V07.8 (other specified prophylactic measure). A secondary diagnosis of V58.0 (encounter for radiotherapy) would be appropriate. The diagnosis of primary lung cancer is the tertiary diagnosis for this treatment.

As authoritative guidance, the American Hospital Association, the entity responsible for maintaining the ICD-9, publishes physician and outpatient coding guidelines. Relevant guidelines that apply to this situation include the following:

List first the code for the diagnosis, condition, problem or other reason for the encounter shown in the medical record to be chiefly responsible for the services provided.

List additional codes that describe coexisting conditions. Code all documented conditions that coexist at the time of the encounter and require or affect patient care, treatment or management.

When coding physician or outpatient services, do not code diagnoses listed as probable, suspected, rule out, questionable or working diagnosis. V codes are assigned when circumstances other than a disease or injury are recorded as diagnoses or problems.

Editors note: Cindy C. Parman, CPC, CPC-H, principal of Coding Strategies Inc., a coding consulting firm in Dallas, Ga., provided advice for answering this question.