The following is a summary of chemotherapy-related guidelines and may be found in the ICD-9-CM Official Guidelines for Coding and Reporting, effective October 1, 2009, pages 23-26: Assign code V58.11, Encounter for antineoplastic chemotherapy, as the principal diagnosis if a patient is admitted solely for chemotherapy administration.
If a patient is admitted only to receive chemotherapy, sequence code V58.11 as the principal diagnosis. Sequence the malignancy (primary or secondary) as the principal diagnosis if a patient is admitted for staging the malignancy or a procedure such as thoracentesis even though chemotherapy may be administered.
Liver cell carcinoma. 2016 2017 2018 2019 2020 Billable/Specific Code. C22.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2020 edition of ICD-10-CM C22.0 became effective on October 1, 2019.
If a patient is admitted with a nonneoplastic condition for chemotherapy, assign the condition as the principal diagnosis; do not assign V58.11. Assign a code for the malignancy as either principal or secondary diagnosis depending on the circumstances of admission if a patient is receiving treatment for a malignancy that has already been excised.
If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy, or radiation therapy assign code Z51. 0, Encounter for antineoplastic radiation therapy; Z51. 11, Encounter for antineoplastic chemotherapy; or Z51.
1 for Encounter for antineoplastic chemotherapy and immunotherapy is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
11, Encounter for antineoplastic chemotherapy; or Z51. 12, encounter of antineoplastic immunotherapy as the first-listed or principal diagnosis.
ICD-10-CM Code for Malignant neoplasm of liver, primary, unspecified as to type C22. 8.
Z51. 11 is attached to the billing for the administration of chemotherapy so would not be used by the provider when the patient is going to a hospital-owned infusion center.
Z85. 3 can be billed as a primary diagnosis if that is the reason for the visit, but follow up after completed treatment for cancer should coded as Z08 as the primary diagnosis.
11 or Z51. 12 is the only diagnosis on the line, then the procedure or service will be denied because this diagnosis should be assigned as a secondary diagnosis. When the Primary, First-Listed, Principal or Only diagnosis code is a Sequela diagnosis code, then the claim line will be denied.
When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.
Intravenous (IV) infusions are billed based upon the CPT®/HCPCS description of the service rendered. A provider may bill for the total time of the infusion using the appropriate add-on codes (i.e. the CPT®/HCPCS for each additional unit of time) if the times are documented.
ICD-10-CM Code for Secondary malignant neoplasm of liver and intrahepatic bile duct C78. 7.
If liver cancer is documented with no further specification stating primary or secondary, assign code 155.2. It is appropriate to query the physician for clarification if the cancer is not specified as primary or metastatic. Benign neoplasm of the liver is assigned to code 211.5.
C78. 7 - Secondary malignant neoplasm of liver and intrahepatic bile duct | ICD-10-CM.
9: Fever, unspecified.
What are antineoplastic drugs? Antineoplastic drugs are medications used to treat cancer. Other names for antineoplastic drugs are anticancer, chemotherapy, chemo, cytotoxic, or hazardous drugs.
Neoadjuvant chemotherapy is a type of cancer treatment where chemotherapy drugs are administered before surgical extraction of the tumor. Your doctor may recommend neoadjuvant chemotherapy to shrink the breast cancer tumor to give him or her more surgical options for your care.
Antineoplastic chemotherapy drugs are a type of medication that doctors use to treat cancer. They contain chemicals that kill cells that rapidly divide, including cancer cells.
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere.
Metastatic liver cancer starts somewhere else and spreads to your liver. Risk factors for primary liver cancer include. having hepatitis. having cirrhosis, or scarring of liver. being male. low weight at birth. symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin.
The 2022 edition of ICD-10-CM C22.9 became effective on October 1, 2021.
A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere.
A type of adenocarcinoma and the most common type of liver tumor.
Lately, an increasing number of tumors have been treated with liver transplantation. A primary malignant neoplasm of epithelial liver cells. It ranges from a well-differentiated tumor with epithelial cells indistinguishable from normal hepatocytes to a poorly differentiated neoplasm.
Malignant neoplasm of liver and intrahepatic bile ducts. Approximate Synonyms. Cancer of the liver, hepatocellular. Liver cell carcinoma (clinical) Clinical Information. (hep-a-toe-ma) a liver tumor. (hep-a-toe-sel-yoo-ler kar-sin-o-ma) a type of adenocarcinoma, the most common type of liver tumor.
Hepatocellular carcinomas quickly metastasize to regional lymph nodes and lung. The overall median survival of untreated liver cell carcinoma is about 4 months. The most effective treatment of hepatocellular carcinoma is complete resection of the tumor.
The Table of Neoplasms should be used to identify the correct topography code. In a few cases, such as for malignant melanoma and certain neuroendocrine tumors, the morphology (histologic type) is included in the category and codes. Primary malignant neoplasms overlapping site boundaries.
A malignant tumor that arises from hepatocytes. Hepatocellular carcinoma is relatively rare in the United States but very common in all african countries south of the sahara and in southeast asia. Most cases are seen in patients over the age of 50 years, but this tumor can also occur in younger individuals and even in children. Hepatocellular carcinoma is more common in males than females and is associated with hepatitis b, hepatitis c, chronic alcohol abuse and cirrhosis. Serum elevation of alpha-fetoprotein occurs in a large percentage of patients with hepatocellular carcinoma. Grossly, hepatocellular carcinoma may present as a single mass, as multiple nodules, or as diffuse liver involvement. Microscopically, there is a wide range of differentiation from tumor to tumor (well differentiated to poorly differentiated tumors). Hepatocellular carcinomas quickly metastasize to regional lymph nodes and lung. The overall median survival of untreated liver cell carcinoma is about 4 months. The most effective treatment of hepatocellular carcinoma is complete resection of the tumor. Lately, an increasing number of tumors have been treated with liver transplantation.
If the site of the primary cancer is not documented, the coder will assign a code for the metastasis first, followed by C80.1 malignant (primary) neoplasm, unspecified. For example, if the patient was being treated for metastatic bone cancer, but the primary malignancy site is not documented, assign C79.51, C80.1.
If the documentation states the cancer is a metastatic cancer, but does not state the site of the metastasis, the coder will assign a code for the primary cancer, followed by code C79.9 secondary malignant neoplasm of unspecified site.
When a current cancer is no longer receiving treatment of any kind, it is coded as a history code. For instance, the patient had breast cancer (C50.xx) and underwent a mastectomy, followed by chemoradiation. The provider documents that the patient has no evidence of disease (NED).
When coding malignant neoplasms, there are several coding guidelines we must follow:#N#To properly code a malign ant neoplasm, the coder must first determine from the documentation if the neoplasm is a primary malignancy or a metastatic (secondary) malignancy stemming from a primary cancer.
Assign code V58.11, Encounter for antineoplastic chemotherapy, as the principal diagnosis if a patient is admitted solely for chemotherapy administration. Assign a code for the malignancy as the secondary diagnosis.
If a patient is admitted only to receive chemotherapy, sequence code V58.11 as the principal diagnosis. Sequence the malignancy (primary or secondary) as the principal diagnosis if a patient is admitted for staging the malignancy or a procedure such as thoracentesis even though chemotherapy may be administered.
Common uses of chemotherapy include destroying or slowing cancer cell growth ; as adjuvant therapy, which destroys hidden cancer cells that remain after another type of treatment; as neoadjuvant therapy, which shrinks a tumor to make other treatments possible; and palliative chemotherapy, which relieves signs and symptoms of advanced cancer, such as pain. It may also be used for nonneoplastic conditions such as bone marrow disease and immune system disorders.
Sequence dehydration as the principal diagnosis when the admission is for managing dehydration due to the malignancy or the therapy and only the dehydration is being treated. Sequence the malignancy as the principal diagnosis when a patient is admitted for surgical removal of a malignancy followed by chemotherapy.
Assign 285.22, Anemia in neoplastic disease, for anemia due to malignancy. Antineoplastic-chemotherapy-induced anemia is classified to 285.3. Do not use 285.22 for anemia due to chemotherapy. Also, it is unnecessary to assign E933.1, Antineoplastic and immunosuppressive drug, along with 285.3 since the adverse effect of chemotherapy information is ...
When a patient is admitted for chemo, the official coding rules state that Z51.12 should be sequenced as the primary diagnosis. When a patient is stable at the time of admit, this rule seems straightforward. When a patient is admitted for chemo and is also experiencing symptoms related to the cancer (i.e. ascites, confusion) how do you select the principal diagnosis? The rules states when the encounter is "SOLELY" for chemo to use the Z code for encounter for chemo. In the context of this rule, I interpret this to mean that the patient did not receive any other treatments such as surgery or radiation but was solely treated with the chemotherapy.
2) Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy If a patient admission/encounter is solely for the administration of chemotherapy, immunotherapy or external beam radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If a patient receives more than one of these therapies during the same admission more than one of these codes may be assigned, in any sequence.
The guidelines state that when the encounter is to determine the extent of the malignancy, or for a procedure such as paracentesis or thoracentesis the malignancy is the PDX. I am paraphrasing from memory. In the scenario you describe the chemo can't be the PDX because a therapeutic paracentesis was performed.
The rules’ for neoplasms are particular nuanced; so, be forewarned the coding in the arena of neoplasms is complex. The coding conventions are over 100 pages long , and well, you get the idea.
When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by adjunct chemotherapy or radiation treatment during the same episode of care, the code for the neoplasm should be assigned as principal or first-listed diagnosis.
BUT, if there are efforts to determine the extent of the cancer or for a definitive procedure used to treat or stage the cancer, such as paracentesis or thoracentesis, the cancer is the principal diagnosis.
At any rate, Your site coders ‘should’ have a good handle on sequencing of neoplasms , particularly when chemotherapeutic efforts are provided in conjunction with other treatments.
Returning to the example of primary breast cancer and secondary bone cancer, if treatment at the present encounter is for the bone cancer, proper sequencing is:#N#C79.5x Secondary malignant neoplasm of bone#N#C50.xxx Malignant neoplasm female breast#N#When treating the patient for both primary and secondary cancers at the same encounter, sequence the primary malignancy first (C50.xxx, C79.5x).#N#If there is cancer in more than one location, and treatment is for the cancer “in general,” sequence the primary malignancy first, followed by all secondary malignancies (in any order).#N#Note: There are codes for cancer of C80.1 Malignant (primary) neoplasm, unspecified and C79.9 Secondary malignant neoplasm of unspecified site. A diagnosis of metastatic cancer not otherwise specified (NOS) is used most often when diagnostic tests were not completed.
Proper coding begins with understanding the verbiage that surrounds a physician’s documentation of a cancer diagnosis.#N #In basic terms, cancer means abnormal cells — cells that do not die when they should, or that change structurally into something other than what they are supposed to be. When an anomalous cell starts to reproduce, it becomes cancer.#N#Metastatic means movement. For instance, cells from the lung are not meant to grow in the brain because lung cells are not capable of performing the functions of brain cells. When abnormal cells occur someplace other than where they originate, metastasis has occurred. Biopsy is used to determine if cells are cancerous, but also if they are from the “wrong” part of the body.#N#Cancer comprised of cells in their original location is primary. Cancer comprised of cells that have metastasized from a different area is secondary. For example, when breast cancer cells metastasize to the bone, the breast cancer is primary and the bone cancer is secondary. Cancer that spreads to a secondary site is considered advanced or metastatic. Cancer commonly spreads to the lymph nodes, liver, lungs, bones, and brain.#N#It’s important to understand that the terms “primary” and “secondary” have nothing to do with the order in which cancers are found. For example, if a biopsy reveals breast cells in the bone, but there is no prior knowledge of breast cancer, the bone cancer is still a secondary cancer, even though it was discovered before the (primary) breast cancer.#N#Cancer may be treated by surgery, chemotherapy, radiation or a combination. Chemotherapy or radiation may be given before surgery to make the cancer smaller (neoadjuvant therapy), or after surgery to prevent further cancer (adjuvant therapy).
Diagnostic coding for neoplasms — especially malignant neoplasms — affects not only provider payment, but (more significantly) patient outcomes and healthcare priorities. The National Cancer Institute estimated that in 2018 more than 1.7 million new cases of cancer would be diagnosed in the United States and more than 609,000 would succumb to the disease. These statistics put into perspective the importance of a coder’s role in documenting these conditions. Here are some tips to help you get it right.
For coders, active cancer means that the patient is receiving treatment for the cancer and history of means the cancer has been eradicated and no treatment is being done. Usually, if a secondary site has been diagnosed from a “history of” a primary site, the original site is no longer considered to be “history of.” This can occur years after the initial treatment for cancer. If the medical record states simply “history of cancer,” you might need to query the provider for more details and consider how your compliance manual defines active treatment.
Cancer may be treated by surgery, chemotherapy, radiation or a combination. Chemotherapy or radiation may be given before surgery to make the cancer smaller (neoadjuvant therapy), or after surgery to prevent further cancer (adjuvant therapy).
Cancer that spreads to a secondary site is considered advanced or metastatic. Cancer commonly spreads to the lymph nodes, liver, lungs, bones, and brain. It’s important to understand that the terms “primary” and “secondary” have nothing to do with the order in which cancers are found.
For example, if a biopsy reveals breast cells in the bone, but there is no prior knowledge of breast cancer, the bone cancer is still a secondary cancer, even though it was discovered before the (primary) breast cancer. Cancer may be treated by surgery, chemotherapy, radiation or a combination. Chemotherapy or radiation may be given ...