scarykeri87
New
Can someone please read this and tell me how it to diagnosis should be coded? There has been no biopsy done, only imaging and is being treated with Radiation Therapy. There is a discrepancy between us coders and the physician. He wants to code it as C79.31 and if we follow coding guidelines, we technically should not be coding it as that as there is no confirmed pathology. But, maybe we are wrong. Patient has a confirmed ovarian cancer. Thank you!!
Impression: CNS lesions concerning for metastatic recurrence of ovarian cancer.
Plan: patient is seen today at the request of medical oncology to review her imaging and discuss the next steps in work-up and management of her CNS lesions. We discussed her oncologic history and consideration that these lesions may be cancer-related. We discussed that absent pathology, any treatment directed to the brain would be under presumption of association with her prior ovarian cancer. MRI is planned later today, to confirm lesion dimensions and characteristics, as well as to provide additional detail concerning potential other CT-occult lesions which may be present. We discussed limitations of systemic therapies to penetrate the brain, and the role of radiotherapy in this setting. We discussed considerations of high-dose, limited-treatment radiosurgery (SRS) versus whole-brain directed treatments, including tradeoffs between toxicity risks, convenience, and CNS control. Given the size and location of the lesions, as well as short interval since surgery and -brain radiotherapy, possibly with left hippocampus-sparing technique (also permitting consideration of central lesion dose escalation and scalp-sparing), reserving SRS for consolidation in the event of residual or salvage in the case of recurrence.
Impression: CNS lesions concerning for metastatic recurrence of ovarian cancer.
Plan: patient is seen today at the request of medical oncology to review her imaging and discuss the next steps in work-up and management of her CNS lesions. We discussed her oncologic history and consideration that these lesions may be cancer-related. We discussed that absent pathology, any treatment directed to the brain would be under presumption of association with her prior ovarian cancer. MRI is planned later today, to confirm lesion dimensions and characteristics, as well as to provide additional detail concerning potential other CT-occult lesions which may be present. We discussed limitations of systemic therapies to penetrate the brain, and the role of radiotherapy in this setting. We discussed considerations of high-dose, limited-treatment radiosurgery (SRS) versus whole-brain directed treatments, including tradeoffs between toxicity risks, convenience, and CNS control. Given the size and location of the lesions, as well as short interval since surgery and -brain radiotherapy, possibly with left hippocampus-sparing technique (also permitting consideration of central lesion dose escalation and scalp-sparing), reserving SRS for consolidation in the event of residual or salvage in the case of recurrence.