Improve Ovarian Cancer Coding Through Awareness

Understanding this devastating disease is key to accurate ICD-10-CM code selection.

Ovarian cancer ranks fifth in cancer deaths among women in the United States, but is the deadliest of the gynecologic cancers, with a five-year survival rate of 46.5 percent. Because of the location of the ovaries in the body, most ovarian cancers go undiagnosed until the late stages of the disease. When diagnosed in the early stages (stages 1 or 2), the percentage of survival is much higher, at 91.2 percent. The reality is, however, that approximately four out of five ovarian cancer patients are diagnosed with advanced disease that has spread throughout the abdominal cavity. A woman’s lifetime risk for developing ovarian cancer is 1 in 79. Approximately 22,240 new cases will be diagnosed, and 14,070 women will die of ovarian cancer in the United States in 2018.
Ovarian cancer was once believed to be one type of cancer originating in the ovaries. Research has shown there are over 30 different types of ovarian cancer, with some starting in the cells in the far end of the fallopian tubes. Knowing the pathology of a patient’s ovarian cancer is important because it dictates the treatment the patient receives. Understanding the different types of ovarian cancers and what they mean will help you assign ICD-10 diagnosis codes to the patient’s claims.

Types of Ovarian Cancer

The ovaries are made up of different cell types and each can develop into a different type of tumor:

• Epithelial tumors begin in the thin layer of tissue that covers the outside of the ovaries. This is the most common type of tumor.
• Germ cell tumors start in the cells that produce the eggs.
• Stromal tumors originate in ovarian tissue that produces the hormones estrogen and progesterone.

Approximately 85 to 90 percent of malignant ovarian cancers are epithelial tumors. Epithelial tumor cells have unique features when reviewed in the lab that can help classify the cells even further by type:

• Serous carcinomas make up 52 percent of epithelial tumors.
• Clear cell carcinoma make up 6 percent of epithelial tumors.
• Mcinous carcinoma make up 6 percent of epithelial tumors.
• Endometroid carcinoma make up 10 percent of epithelial tumors.

After determining the type of epithelial ovarian carcinomas, pathologists are then able to assign a grade based on how similar the tumor cells look to normal healthy tissue.

• Grade 1 epithelial ovarian carcinomas look more like normal tissue and tend to have a better prognosis.
• Grade 3 epithelial ovarian carcinomas look less like normal tissue and usually have a worse prognosis.

Five percent of ovarian cancers are germ cell carcinoma tumors. These tumors are found mostly in women in their early 20s. There are six kinds of germ cell tumors, but the most common types are teratomas, dysgerminomas, and endodermal sinus tumors. Many germ cell tumors are benign.
An additional 5 percent of ovarian cancers are stromal carcinoma tumors. The two most common types of stromal tumors are granulosa cell tumors and Sertoli Leydig cell tumors. Stromal tumors are often diagnosed in stage 1.

Ovarian Cancer Diagnosis Coding

Per the ICD-10 2018 coding guidelines, “To properly code a neoplasm it is necessary to determine from the record if the neoplasm is benign, in-situ, malignant, or of uncertain histologic behavior.” Although there are many types of ovarian cancer, malignant, in situ, and benign ovarian cancers fall under the following ICD-10 codes.
Malignant ovarian cancer ICD-10 codes, include:

C56          Malignant neoplasm of ovary

C56.1   Malignant neoplasm of right ovary

C56.2   Malignant neoplasm of left ovary

C56.9   Malignant neoplasm of unspecified ovary

The ICD-10 code for ovarian cancer tumors that are in situ, or encapsulated within the organ:

D07.39   Carcinoma in-situ of other female genital organs

Benign ovarian cancer ICD-10 codes, include:

D27    Benign Neoplasm of Ovary

D27.0 Benign neoplasm of right ovary

D27.1 Benign neoplasm of left ovary

D27.9 Benign neoplasm of unspecified ovary

Ovarian Cysts Should Be Monitored

Ovarian cysts, although not cancer, should be monitored closely, particularly on females who are not ovulating. Cysts should cause concern if they do not go away in a few months. Although most cysts are benign, some can become cancerous.
The following ICD-10 codes are used when a patient has an ovarian cyst:

N83.0     Follicular cyst of ovary

N83.00          Follicular cyst of ovary, unspecified side

N83.01          Follicular cyst of right ovary

N83.02          Follicular cyst of left ovary

N83.1     Corpus luteum cyst

N83.10          Corpus luteum cyst of ovary, unspecified side

N83.11          Corpus luteum cyst of right ovary

N83.12          Corpus luteum cyst of left ovary

N83.2     Other and unspecified ovarian cysts

N83.201        Unspecified ovarian cyst, right side

N83.202        Unspecified ovarian cyst, left side

N83.209        Unspecified ovarian cyst, unspecified side

N83.29   Other ovarian cysts

N83.291        Other ovarian cyst, right side

N83.292        Other ovarian cyst, left side

N83.299        Other ovarian cyst, unspecified side

Spread Awareness

Although ovarian cancer can be hard to detect and is often treated in the later stages, there are signs and symptoms that can be recognized by patients and their families. An easy way to identify and remember the symptoms is with the acronym BEAT:

• Bloating that is persistent
• Eating less, feeling fuller
• Abdominal and/or back pain
• Trouble with your bladder and bowels

If you have these signs and symptoms, make an appointment with your gynecologist. Help spread awareness this month by sharing BEAT!

To learn more about ovarian cancer coding on the AAPC Knowledge Center, read these articles:
Keep Up with Current Treatment for Ovarian Cancer
Ovarian Cancer Early Detection Is Vital to Survival
A&P Tip: Ovarian Cancer

Resources
American Cancer Society 2018: www.cancer.org/cancer/ovarian-cancer/about/what-is-ovarian-cancer.html
Norma Leah Ovarian Cancer Initiative: http://normaleah.org/
Ovarian Research Fund Alliance (OCRFA): https://ocrfa.org/patients/about-ovarian-cancer/types-ovarian-cancer/

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Bridget Toomey

Bridget Toomey, MS, CPC, CPB, CPPM, AAPC Fellow, RYT-200, is the assistant director of Clinical Operations in the department of Obstetrics and Gynecology at University of Iowa Health Care. She is a certified Kundalini yoga teacher and serves as the wellness ambassador for the department of OB-GYN. Toomey received her Master of Science in Health Care Management from Johns Hopkins University. She is the vice president of the Iowa City, Iowa, local chapter.

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