ICD-10: C22.- Adds Specificity to Liver Neoplasm Coding   (October 2011)

Hepatocellular carcinomas and hepatoblastomas split paths under ICD-10.When you start using ICD-10 in 2013, you’ll have to leave your 155.0 comfort zone and start using more specific codes for primary liver neoplasms.ICD-9: A number of diagnoses fall under the ICD-9 code you currently use:155.0, Malignant neoplasm of liver primary Carcinoma: liver, specified as primary hepatocellular liver cell HepatoblastomaICD-10: The new code set does not provide a one-to-one corresponding code. Instead, you’ll need to choose from [...]

You Be the Coder: Set Aside Uncertain Neoplasm Confusion   (October 2011)

Question: I have a physician who wants to use “uncertain behavior neoplasm, breast” instead of “lump in breast” prior to testing. When is it appropriate to use uncertain behavior instead of lump? SuperCoder.com MemberAnswer: You should not use an uncertain behavior code, such as 238.3 (Neoplasm of uncertain behavior of breast), before the oncologist has reviewed the pathology report and confirmed the neoplasm meets certain conditions for uncertain neoplastic characteristics. In the scenario you describe, [...]

Reader Question: J3430 Applies to Vitamin K   (October 2011)

Question:  My physician gave a patient a 10 mg injection of vitamin K. How should I report this? Texas Subscriber Answer:  You should report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection. For the vitamin K itself, you’ll use J3430 (Injection, phytonadione [vitamin K], per 1 mg). Then place 10 in the units column because your physician gave a 10 mg injection, and the code is reportable [...]

Reader Question: 189.3 Isn’t Only Urethra Tumor Possibility   (October 2011)

Question: Which ICD-9 code should I use when the doctor documents “tumor of the urothelium of the prostatic urethra”? Florida Subscriber Answer: If the tumor is malignant you should use 189.3 (Malignant neoplasm of kidney and other and unspecified urinary organs; urethra). However, if it’s benign, use 223.81 (Benign neoplasm of urethra) instead. Alternative: For a polyp of the urethra, use 600.20 (Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms [...]

Reader Question: J9999 Describes Adcetris for Now   (October 2011)

Question: How do we code for Adcetris administration? Virginia Subscriber Answer: According to Palmetto GBA, J11 Part B MAC for Virginia, you should submit the following: CPT®: 96413, Chemotherapy administration, intravenous infusion technique; up to one hour HCPCS: J9999, Not otherwise classified antineoplastic drugs ICD-9: 200.60-200.68 (Anaplastic large cell lymphoma) or 201.00-201.98 (Hodgkin’s disease), depending on documentation. Enter a single unit for the HCPCS code. A 30 minute IV infusion is the typical administration method, [...]

Reader Question: 99241-99245 Require Face-to-Face Encounter   (October 2011)

Question: If our physician only reviews patient records, but doesn’t actually examine the patient, may we bill a consult (assuming the payer accepts consult codes)?Oregon SubscriberAnswer: Before you report a consult code, you need to be sure the service meets the requirements, including:Written request from a physician or other appropriate sourceMedically necessary reason for the consultationFace-to-face history, exam, and medical decision-making (MDM) rendered by the physician for the patient’s problemWritten report sent to the requesting [...]

ICD-9 2012: 282.4x Bulks Up Your Thalassemia Coding Options Starting October 1   (October 2011)

Pancytopenia, CVC infections, and more land a spot in the update.Although you can get a glimpse at ICD-9 updates each summer in CMS’s proposed Inpatient PPS rule, ICD-9 can fit in plenty of changes before the new code set becomes official. Check out the codes below, which weren’t finalized in time to be included in the proposed rule, but are effective Oct. 1, 2011, all the same.Is Your Documentation Up to the Thalassemia Challenge?ICD-9 2012 [...]

Part 2: Diagnosis Coding: 285.3 vs. 284.89: Documentation of ‘Aplastic’ Can Help Steer Your Coding   (September 2011)

Discover which condition is more likely to be caused by chemotherapy.Patients with cancer may develop anemia from a number of causes. Here are some clues to help you pinpoint the source and keep your coding compliant.Flashback: Last month, Oncology & Hematology Coding Alert, vol. 13, no. 9, discussed coding treatment of anemia caused by cancer (see “Part 1: 285.22 Scenario Reveals Importance of Following Official Guidelines”). This article digs deeper into proper anemia coding, looking [...]

Diagnosis Coding: 6 Tips Help Keep Your ICD-9 Coding on Track   (September 2011)

Cheat sheets come with a warning label.To help ensure your coding complies with ICD-9 guidelines, there are several tactics you can use:1. Always read the notes in the ICD-9 manual that apply to the code you’re considering, says Denae M. Merrill, CPC, HCC coding specialist in Michigan. 2. Read the ICD-9 official guidelines that apply to your “specialty periodically as a refresher. If we only read them when the codes change once a year, it [...]

ICD-10: 153.8 Makes Way for C18.8, Putting the Focus on Overlapping Sites   (September 2011)

Anatomic sites will remain important for choosing colon neoplasm codes.Under ICD-9, finding the code for colon cancer of overlapping sites takes some detective work. ICD-10 will make the task a little easier.ICD-9: In some colon cancer cases, physicians can have a hard time determining the cancer’s primary site if the cancer has already reached neighboring tissue. Under ICD-9, you use 153.8 (Malignant neoplasm of other specified sites of large intestine) to describe this diagnosis. The [...]