Radiology Coding Alert

Question: If we have a confirmed primary site for cancer, and an oncologist requests a CAT scan of the chest, abdomen and pelvis looking for metastases, may we use a neoplasm code of uncertain behavior? The physicians are uncertain as to the behavior of the primary tumor. Or, should we use 199.0 (malignant neoplasm without specification of site; disseminated) or 199.1 (malignant neoplasm without specification of site; other), essentially occult malignancy?

Anonymous California Subscriber

Answer: There may be more than one correct answer to this question, depending on the details and the primary diagnosis, says Linda Lively, MHA, president and CEO of American Medical Accounting and Consulting in Marietta, Ga., which has specialized in coding, training and auditing for radiation oncology practices for more than 16 years.

If the physician is attempting to diagnose a metastasis, it would be appropriate to code the symptoms, if there are anysuch as bone pain (733.90, disorder of bone and cartilage, unspecified) as the primary reason for the encounter. You could then code the primary site of the cancer as the secondary reason for the encounter (i.e., breast neoplasm, 174.9). This approach would be my preference, Lively adds.

There are also V codes that could be used as the primary reason for the encounter, with the primary site of the cancer as the second reason. These codes are V67.1 (following radiotherapy), V67.2 (following chemotherapy) and V58.0 (encounter for radiotherapy).

This reader might be able to use the reference to neoplasm, uncertain behavior, however the site and the type of the second occurrence would be difficult to make, since this seems to be the reason for the diagnostic radiology work-up.