Properly Coding Different Types of Tumors is Key For Maximum Reimbursement
You must be well aware of the different ways of interpretations of various types of diseases for coding purposes. For example, if you are coding biopsies you must have a real understanding about the primary and secondary malignancies. By ‘primary neoplasm code’ the reference is made to the exact ‘first site of tumor’ and when the reference is about ‘secondary neoplasm’ it denotes the areas to which the malignancy has spread.
So even after the original ‘Metastatic tumor’ has been removed if the patient still has the disease spread to some other areas of the body, the coding can be continued; but not as ‘primary’, as a ‘secondary’ one.
Here it should be noted that as per the ICD-9 2009 official procedures, in-case the first reported tumor of the patient has been wiped-out and if he/she does not require further treatment, the coder must employ a ‘record of’ codes like V10.3. Page 24 of the above mentioned ICD-9 2009 very clearly mention about this point. There are some terms which you should clearly understand before doing neoplasm coding which will prevent you from denials.
Now let us try to understand some of these.
Malignant:
Whenever the nature of a common tumor changes from an ordinary growth or swelling to a cancerous structure which pose real threat to life and can spread to other body parts, we use the word ‘malignant’.
Primary:
When the various tests conducted on the patient reveals that the tumor is a suspected cancer, you can use the word ‘primary’.
But if the consulting physician is not sure about the origination point and the tumor has overlapped into more areas, a code for ‘contiguous’ sites can be used.
Secondary
If the primary nature of the tumor has crossed the limits and has entered into a more serious phase like entering into other parts of the body like lymph nodes, liver, lungs or brain then the secondary malignancy codes also has to be made in the claim forms. Here you have to note both the primary and secondary codes while doing the coding.
Ca in situ
This is the short form of ‘Carcinoma in Situ’ and denotes malignancies that have not yet spread to other parts, but which are really big ones that can trigger serious problems. It has to be noted here that in some cases like breast (233.0), bladder (233.77) and cervix (233.1) no guarantee can be provided about the complete cure of cancer, even if the ‘growth’ can be removed.
Benign
These are growths or cysts which are not at all cancerous like the ‘fibro adenoma’ of breast which does not pose the threat of spreading like ‘benign neoplasm (217)’. It is to be noted that ‘benign’ neoplasm can return even after removal but do not have invasive nature. You can be sure that the ICD-9 alphabetic index will recognize the cyst as ‘benign’ though the reports are not stating it as ‘benign’.
Uncertain behavior
If there are certain suggestions like ‘atypia’ or ‘dysplasia’ in the pathology report, you can be sure that the growth is in a ‘change-over’ period from the ‘benign’ to ‘malignant’ stage. In this case if this is left without proper treatment it is only a matter of time for it to get fully malignant. If you go by the pathology report and the ICD-9 index you will know when to use the code of ‘uncertain behavior’.
Unspecified
There will be some unusual cases where the physicians are not sure of the character of the ‘neoplasm’ and the pathology report will not authenticate the true nature of the growth. In this case you can use the ‘unspecific code’ while coding. But special attention should be taken to differentiate between the ‘uncertain’ and ‘unspecified’ codes. Go always according to the pathological reports.
These different coding classifications can help you maximize your reimbursements and capture all the revenue you deserve. In this uncertain environment of revenue reduction, and the ever continuing complicated billing requirements, it is becomes even more necessary to understand the proper use of the codes needed that link what you do to what you bill. Remember, you do the work, you deserve to be paid for what you do.
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