Oncology & Hematology Coding Alert

Watch out: 1 common coding tool could be costing you time and money  Finding the right diagnosis code for your Hodgkin's patient can require some real sleuthing skills. Good news: The clues you need for success are right in your ICD-9 manual. See what the experts suggest when hunting down the most specific code.

Why it matters: Payers look at the ICD-9 code to determine whether the diagnosis supports medical necessity for the treatment plan and any ancillary services, such as radiology or labs, says Carolyn M. Davis Hutt, CMA, CPC, CCP, CCS-P, CPHT, RMC, reimbursement coordinator with Oncology Hematology West in Omaha, Neb., in her Coding Institute teleconference, -Accurate Neoplasm Coding Step-by-Step.-

Sample diagnosis: Suppose your documentation says your patient has Hodgkin's disease, nodular sclerosis, intrapelvic lymph nodes. Here's how to determine the appropriate diagnosis codes. 1. Begin Your Search in the Alphabetic Index  Your first instinct when coding cancer may be to head to the neoplasm table, but when you have the name of a specific condition, you should look up the term in the alphabetic index instead.
 
Example: To find the appropriate code for our sample diagnosis, you should look up -Hodgkin-s- in the alphabetic index. The listings for Hodgkin's disease include an entry for nodular sclerosis -- 201.5. 2. Let Symbols Guide You to Greatest Specificity  Many ICD-9 manuals include symbols to alert you when a code requires an additional digit.
 
Example: The alphabetic index entry for -Hodgkin's disease, nodular sclerosis- in the AMA's Physician ICD9-CM 2007, Volumes 1 and 2, has a checkmark next to the entry, meaning -additional digit required -- refer to the tabular list for digit selection.-
 
Tip: Learn the symbols your ICD-9 resource uses so you won't miss any clues regarding whether you need a more specific code.

3. Verify Your Choice in the Tabular List  You should always look in the tabular list to read the code descriptor and ensure that you-re reporting the most accurate code, regardless of whether the alphabetic index listing directs you to the tabular list.
 
Example: You turn to 201.5 and see the descriptor Hodgkin's disease; nodular sclerosis.
 
In many manuals, this entry offers another reminder that you need to look for an additional digit with a symbol such as --5th- or -+.- Note: If you instead turned first to 201 (Hodgkin's disease) you might see a symbol, such as --4th,- reminding you that the three-digit code 201 is incomplete. When you narrow in on four-digit code 201.5, you-ll see the symbol directing you to add another digit.
 
Key idea: If the ICD-9 code you submit is not as specific as carrier rules require, the carrier may reject the claim for lack of medical necessity or simply because you reported a truncated [...]