Oncology & Hematology Coding Alert

Question: A patient presents for palliative radiation therapy aimed at a secondary neoplasm on the middle lobe of the lung to ease breathing problems. Which diagnosis codes should I report?

Pennsylvania Subscriber

Answer: This case requires more than one diagnosis code. Assuming the patient presents solely for radiation therapy, you should report V58.0 (Encounter for radiotherapy) as your principal diagnosis, according to the ICD-9 official guidelines (available at www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm).

Here's why: The guidelines indicate that you typically should report the treated malignancy as the principal diagnosis. The only exception is when the "encounter is solely for the administration of chemotherapy,  immunotherapy, or radiation therapy." In that case, the encounter code is primary and the malignancy treated is a secondary diagnosis.

Because the provider treats only the secondary site at this encounter, report the secondary neoplasm next using 197.0 (Secondary malignant neoplasm of respiratory and digestive systems; lung). You may report the appropriate primary malignant neoplasm code following 197.0.

You then should report V66.7 (Encounter for palliative care) to indicate that the service was for palliative care. And you may report the symptom he treated, as well, such as 786.05 (Shortness of breath).