User:Alwyn2/sandbox

Primary Cancer:To correctly report a diagnosis of cancer, the coder/reviewer must determine whether the patient’s cancer has been eradicated or is currently being treated. Cancer codes (categories 140-238) are to be used for patients with documentation of active treatment for the condition. This applies even when the patient has had surgery to remove the cancer but is still receiving treatment for the disease, such as antineoplastic medications. So long as the patient continues to receive such treatment, the patient’s cancer should be coded as a current, active disease condition (categories 140-238). Cancer for which treatment is no longer being received would be coded with a V-code for “History of malignant neoplasm;” these are not included in the CMS-HCC and Rx-HCC models. When the cancer is in its active phase: Refferals to Oncologist can be considered as evaluation (i.e. no prior surgery (or) treatment should have been provided to the patient) and it should be addressed in the assessment. Reference : Client Call; Known From Shantell; Date: 07/18/2013. When the cancer is documented along with s\p surgery (or) treatment: Refferals to oncologist can be considered as evaluation only when the patient is again reffered for any ongoing management (i.e. the document should say, “reffered to oncologist for chemotherapy (or) radiation theraphy). Note: A patient may be prescribed antineoplastic medications for reasons other than active cancer (e.g. prophylaxis). In this case, do not code cancer. Metastatic/Secondary Cancer: The site of secondary (metastatic) cancer should be coded whenever documented. If a cancer is described as “metastatic of/to” a particular site, that site should be considered secondary, and the cancer should be coded as secondary from the Neoplasm Table of ICD-9-CM. If the primary cancer is still present, it should be coded as well; if it has been completely eradicated, it should not be coded. When both primary and secondary cancers are coded, sequence first the condition which was the most significant driving reason or purpose of the provider visit or treatment. All cancers are assumed to be primary, except the following sites, which are assumed to be secondary per CMS guidelines: bone, brain, diaphragm, heart, liver, lymph nodes, mediastinum, meninges, peritoneum, pleura, retro peritoneum [sic], and spinal cord. For example: if bone cancer is stated but not specified as primary or secondary, the correct code is 198.5 (neoplasm, bone, malignant, secondary).1 Unspecified Site: If the site of a cancer (primary or secondary) is not stated, use code 199.1 (Other malignant neoplasm of unspecified site). Cancer Examples: a. Patient status-post mastectomy for breast cancer, on Tamoxifen: 174.9 b. Secondary malignant neoplasm of kidney: 198.0. (Known secondary site (kidney).) c. Metastatic carcinoma from lung: 162.9, 199.1. (Known primary site (lung); unknown secondary site.) d. Patient admitted with metastatic bone cancer; had mastectomy two months ago and is having radiation treatments for breast cancer: 198.5, 174.9. (Neoplasm, bone, secondary; neoplasm, breast (primary)) Malignant Neoplasm Of Lymphatic And Hemopoietic Tissues: 203.xx - Multiple myeloma and immunoproliferative neoplasm : An uncontrolled proliferation of plasma cells and itresults in number of organ dysfunctions. 204.xx - Lymphoid leukemia : Malignan proliferation of immature lymphocytes called lymphoblasts. The chronic condition (CLL) is a generalized progressive form of lymphocytic leukemia. 203.xx - Multiple myeloma and immunoproliferative neoplasm : An uncontrolled proliferation of plasma cells and itresults in number of organ dysfunctions. 205.xx - Myeloid leukemia : A rapid and malignant proliferation of immature myelocytes. The chronic condition is a fatal disease characterized by abnormal proliferation of premature granulocytes in the bone marrow, peripheral bold and body tissues. 206.xx - Monocytic leukemia. 207.xx - Other specified leukemia : This rubric is reversed for several leukemias that do not classify to the other rubrics. Leukemias of unspecified cell types are classified to rubric 208. 208.xx – Leukemia of unspecified type: Use these leukemia code when documentation does not provider sufficient information (or) when the patient specific diagnosis has not yet been established but leukemia is certain. The following fith-digit sub classification is for use with categories 203, 204, 205, 206, 207 and 208: 0 without mention of having achieved remission 1 in remission 2 in relapse Relapse (or recurrence of leukemia) occurs when the diseas returns after it has been treated (remission). If the physician documents that the patient’s leukemia has been completely cured use V10.6x. Only when documentation specifically indicates the leukemia is in remission should be coded as such. Note: “Lymphoma patients who are in remission are still considered to have lymphoma and should be assigned the appropriate code from the categories 200-202 (AHA Coding Clinic for ICD-9-CM, 1992, second quarter, page 3). If the disease is completely cured and the provider documents “history of”, assign the code V10.79”. CLL and Leukemia Specifics: Goal is not to cure but to put the disease in remission. Leukemia patients can be observed with careful and frequent follow-up exams. There are 5 stages of CLL, 0-IV, even if a CLL is staged “0” this is still considered as cancer, It does not mean there is no cancer. The chronic type of this cancer grows slowly and not everyone needs to be right away. When warrented, initial reatment is usually chemotheraphy. While many people live a long time with chronic leukemia, in general it is very difficult to cure.