Cover All of Your Head and Neck Cancer Coding Bases
Published on Sat Mar 18, 2006
You may need to apply new-for-2006 demonstration project and neutron treatment codes
April is a great time to jump to the head of the head and neck cancer coding class because April 17-23 is Oral, Head, and Neck Cancer Awareness Week.
Head and neck cancer includes cancer of the lips, oral cavity, pharynx, larynx, paranasal sinuses, nasal cavity, ear, and salivary glands, but not the brain.
The diagnosis codes you-re most likely to use include the following:
- 140.x--Malignant neoplasm of lip
- 141.x--Malignant neoplasm of tongue
- 142.x--Malignant neoplasm of major salivary glands
- 143.x--Malignant neoplasm of gum
- 144.x--Malignant neoplasm of floor of mouth
- 145.x--Malignant neoplasm of other and unspecified parts of mouth
- 146.x--Malignant neoplasm of oropharynx
- 147.x--Malignant neoplasm of nasopharynx
- 148.x--Malignant neoplasm of hypopharynx
- 160.x--Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses
- 161.x--Malignant neoplasm of larynx. Note: Remember to report the most specific diagnosis code possible. Your ICD-9 manual instructs you to code each of these ranges to the fourth digit. Translation: Your documentation shows a primary diagnosis of a base-of-tongue malignant neoplasm. Report 141.0 (Malignant neoplasm of tongue; base of tongue), not 141 (Malignant neoplasm of tongue).
Assign code 195.0 (Malignant neoplasm of other and ill-defined sites; head, face, and neck) when your physician documents a primary-site head and neck malignant neoplasm but he can't determine the point of origin. Determine Need for V or E Code Patients may develop head and neck cancers after exposure to certain carcinogens.
Physician documentation rarely shows a definitive link between a specific external cause and the cancer, says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, president of MJH Consulting in Denver.
Your physician may decide to document a history of exposure to a hazardous substance, instead.
Example 1: You-re filing a workers- compensation claim. The physician documents that a neck cancer patient has a history of asbestos exposure due to his work in construction. You report V15.84 (Exposure to asbestos) along with the other appropriate ICD-9 and CPT codes to paint a complete picture for the payer.
Example 2: Your physician documents that the patient received radiation treatment for a previous, unrelated cancer. You report V15.3 (Other personal history presenting hazards to health; irradiation).
If--and only if--your physician specifically documents a link between a hazardous substance and the cancer, you may indicate this connection with the proper E code, Hammer says.
Example: Your physician documents that a patient's tumor is the late effect of accidental exposure to radiation. You have the option of reporting E929.8 (Late effects of other accidents).
Don't stress: Reporting E codes is usually elective because payers consider E codes to be supplementary to the ICD-9 diagnosis codes, Hammer says. Exception: You-re required to report the causative substance for an adverse effect of a drug, medicinal, or biological [...]
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