Wiki Consistent Coding of Neoplasms

[LDWilliams62]

I am a new coding QA auditor and encountered the following situation:

On an inpatient encounter for chemotherapy, the doctor documented the previously diagnosed neoplasm as a primary central nervous system lymphoma (Large B-cell). The coder coded it as primary central nervous system lymphoma, which is code 200.50; but the problem list from the previous admission already had this neoplasm coded as Large B-cell lymphoma, which is code 202.80.

Which code should be used? The one that had already been assigned for this neoplasm or the the one for the primary central nervous system lymphoma? I think the previously assigned code should be coded for the neoplasm to maintain consistency. My reasoning is that the insurance company may think that this is a new diagnosis if they receive a different code for the same neoplasm. Any thoughts?

 

[Tonyj]

I am a new coding QA auditor and encountered the following situation:

On an inpatient encounter for chemotherapy, the doctor documented the previously diagnosed neoplasm as a primary central nervous system lymphoma (Large B-cell). The coder coded it as primary central nervous system lymphoma, which is code 200.50; but the problem list from the previous admission already had this neoplasm coded as Large B-cell lymphoma, which is code 202.80.

Which code should be used? The one that had already been assigned for this neoplasm or the the one for the primary central nervous system lymphoma? I think the previously assigned code should be coded for the neoplasm to maintain consistency. My reasoning is that the insurance company may think that this is a new diagnosis if they receive a different code for the same neoplasm. Any thoughts?

You code what the physician documents. It is not up to us to maintain consistency but to code as accurately as possible. It may help to review the path report and query the physician.