Coding Neoplasms (Cancer)

Data Validation

It is important for your practice to make sure that the If the patient’s cancer metastasizes to other area(s) of the documentation in the medical record is updated for body, it is important to make sure that the medical record is each visit and that the coder/biller has the most updated and the appropriate diagnoses are submitted on current and accurate information in order to assign the claim. the correct code(s). Example: Patient is diagnosed with lower inner-quadrant During data validation audits, we have found that many right breast cancer in May. The ICD-9-CM code is 174.3 oncology practices are not documenting and/or coding malignant, primary (ICD-10: C50.311). The patient returns the health status of cancer patients correctly. in December and now has lower inner-quadrant right breast cancer, and the cancer has metastasized (spread) In recent chart reviews, we have found the following: to lymph gland, axillary area. The patient’s current condition should be documented in the medical records • Cancer mentioned in the documentation but not and the ICD-9 code now is 174.3 (ICD-10: C50.311) for coded on the claim; cancer codes on claims, primary site (neoplasm, breast, right, malignant, primary), but not in the documentation (these must match). and also metastasis to lymph gland, axillary (neoplasm, • Secondary cancer (metastasis) coded in lymph, gland, axillary, malignant, secondary) in which documentation, but not captured on claims. ICD-9 code 196.3 (ICD-10: C77.3) should be submitted on the claim. • Practices using current cancer codes in both documentation and claims after the cancer has Metastasis is listed in ICD-9-CM and ICD-10 as malignant been “cured” or in remission and is no longer being secondary and whenever this takes place, it should be coded treated. The “history of” V codes should be used first by site, then malignant secondary. List the primary code(s) for ICD-9 and “Z” codes for ICD-10. first, then all of the secondary (metastasis) site(s) second. The coding guidelines will be the same in ICD-10.

How to Code the Active Neoplasm or Cancer In-active neoplasm or cancer is coded when a patient is no longer receiving treatment for cancer and the cancer 1. Go to the “Table of Neoplasms” in the International is in remission by using the V “history of” code (“Z” code Classification of Disease (ICD) coding manual. for ICD-10). 2. Find the anatomical site. Example: Patient was diagnosed with prostate cancer, 3. Choose whether the neoplasm is primary or but underwent a TURP (transurethral resection of secondary malignant, in situ, benign, of uncertain prostate) procedure and has since been “cancer free” behavior, or of unspecified nature or behavior with no recurrence. When the patient comes back for future visits, the appropriate ICD-9 code to use is V10.46 Important! When assigning diagnosis codes to - Personal history of malignant prostate (ICD-10: Z80.42) cancer, it is sometimes necessary to change or update the originally diagnosed code as the Since the patient is no longer receiving treatment for cancer progresses. Watch for these changes this condition, it would now be inappropriate to use the and document/code appropriately! current condition code for malignant neoplasm, prostate once the cancer is “cured” or in remission. It is very important to show this historical condition in current history since it can affect other conditions the patient may have.

If you have any questions about coding neoplasms (cancer), please submit your questions to the [email protected]. We will be happy to assist you.

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