Ask An Expert: coding
| Q: | One of our patients was treated for breast cancer in 2007, and the PCP has checked ICD-9-CM code 174.9 on the superbill. Is this correct? |
| A: |
In all likelihood, no. 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 … Read Full Post |
| Q: | My PCP documented and coded breast cancer (ICD-9-CM code 174.9) for a patient who had a mastectomy in 2008 and is receiving Tamoxifen. He was told that if the patient was receiving treatment, he could code active cancer. Is this correct from an MRA standpoint? |
| A: |
Yes and no. When a patient has an active cancer, regardless of whether he or she is receiving treatment, the primary cancer ICD-9-CM code is used. The scenario you presented isn’t quite so clear. Breast cancer has a treatment phase … Read Full Post |
| Q: | The PCP documented “aortic atherosclerosis.” How do I code this for MRA purposes? |
| A: |
Atherosclerosis of the aorta is a common condition in the elderly and the ICD-9-CM code is 440.0. However, it’s important to distinguish the difference between atherosclerosis of the vessel (which is a risk adjusted diagnosis) and a valve (ICD-9-CM code … Read Full Post |
| Q: | A specialist’s consultation report came back three weeks after our patient had a face-to-face visit with the PCP, and revealed some new risk adjusted diagnoses. Can my PCP make an addendum and report them? |
| A: |
Probably not. An addendum is used when the patient was assessed for a condition during the visit and the PCP needed some additional information, to be received very timely, in order to make a definite diagnosis. Addenda are not used … Read Full Post |