Coding Cancers: A Common Charting Error

One of the most common provider charting errors occurs in the area of cancer diagnoses.  Practitioners routinely document and code cancers when the patient’s disease has been treated and is no longer evident.  For risk adjusted practices, this means the patient’s risk score – and the practice’s reimbursement – are inflated, which can lead to positive (which are a bad thing) audit findings and loss of capitation.  

The coding guidelines for cancer state that “When the primary malignancy has been excised, no further treatment is directed to the site & there is no evidence of an existing malignancy,” the clinician must document ‘history of XYZ cancer’ and not the cancer diagnosis. [Source:  International Classification of Diseases, 9th Edition, 2011]  Cancer histories are coded from the v10 category of codes (Personal history of malignant neoplasm) and are not weighted diagnoses under risk adjustment.  For MRA, it’s important to remember that funding losses are retroactive, so the impact of this error to the provider can be quite significant.

 The rule of thumb for a cancer diagnosis is the presence of an active condition:  either one that is receiving treatment, or one that has been diagnosed via objective means and for which treatment is not pursued at the time (for any reason).

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4 Responses to Coding Cancers: A Common Charting Error

  1. Sherri says:

    We have a prospective documentation education program. Would it be appropriate to query physicians on unclear documented cancer when documentation does not support any active treatment or that treatment is not pursued? If so any suggestions to make this query non leading?

    Any help would be appreciated.

    Thanks,

    Sherri Idlebird, CPC
    Senior Coding and Documentation Education Trainer

    • admin says:

      Hello and thanks for your question!

      Absolutely. Coding cancers is one of the most common errors we see in medical charts. Physicians often alternate between the cancer and the history despite no treatment or even a removal of the cancerous organ many years before! We would suggest that you educate them on the coding guideline regarding cancers so they will understand the context of your question and show them how to code histories.

      Hope this helps and thanks for your comment,

  2. Lueberta Mayfield says:

    Patient with effusion, acute anc chronic heart failure, history of breast cancer. Effusion taped, cytology came back positive for lung cancer. Report after patient dischargde home, although the pulmonollogist stated highly suspected for cancer. Attending refused to lister cancer as a diagnosis. Can it be coded with other doctors documentation

    • admin says:

      In short, no, not the way you described. If the report came back very soon after the patient was seen in the office and the patient’s possible cancer diagnosis was assessed/documented during the PCP visit (based on the pulmonologist’s report as suspicious for cancer), then your PCP could make an addendum to the original note. However, please understand that this is a gray area. The condition had to have been assessed by the PCP during the visit and he was waiting for a piece of confirming evidence to “close that loop.” If a long period of time has elapsed, or if the PCP did not document anything to do with this condition and the suspicion of cancer, you would need to bring the patient in for another visit. PCPs usually do a hospital follow-up visit so that should not be a problem to do. Your doc would review the admission records and D/C summary and document accordingly. Also, consider that if the pt follows up with the pulmonologist after discharge, the pulmonologist should also document the cancer.

      Hope this helps. If not, please call the office to discuss. Thanks!

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