Oncology & Hematology Coding Alert

Are you remembering to use the new bilateral codes?

Cancer coding is more art than science, and coding for ovarian cancer provides a good example of this. Not only are there new diagnosis codes to use, but there are a lot of encounter codes that you need to learn to report correctly, too.

So, here are five myths about the ICD-10-CM ovarian cancer codes that we’ve busted for you to keep your neoplasm of ovary coding on point.

Myth 1: You Cannot Use 1 Code for Bilateral Ovarian Cancer

This first myth is easy to dispel, though up until Oct. 1, 2021, it was true. Historically, to code bilateral ovarian cancer, you had to use two codes: C56.1 (Malignant neoplasm of right ovary) and C56.2 (Malignant neoplasm of left ovary). However, ICD-10-CM 2022, effective Oct. 1, 2021, introduced a new ovarian cancer code — C56.3 (Malignant neoplasm of bilateral ovaries) — that you can use to report the bilateral form of the disease.

You also have another new code, C79.63 (Secondary malignant neoplasm of bilateral ovaries), to report cancer that has metastasized to both ovaries.

And remember: The C56.- (Malignant neoplasm of ovary) codes all carry a “use additional code” instruction that asks you to use an additional code for any functional activity. This means adding codes, when appropriate, for conditions such as:

• E25.8 (Other adrenogenital disorders)
• E28.0 (Estrogen excess)
• E28.1 (Androgen excess)
• E28.8 (Other ovarian dysfunction)
• E30.1 (Precocious puberty)

Myth 2: There is No Way to Indicate Ovarian Cancer Due to Genetic Mutation

While it may be true there is no single, specific ICD-10-CM code, you can use a combination of codes to indicate if a patient’s ovarian cancer is due to susceptibility to mutations in the BRCA1 and BRCA2 genes and the genes associated with Lynch Syndrome (MLHL, MSH2, MSH6, PMS2, and EPCAM). If your provider notes this in the patient’s history, use two codes — the appropriate code for the ovarian cancer and Z15.02 (Genetic susceptibility to malignant neoplasm of ovary) — to indicate both the ovarian cancer and the genetic susceptibility.

Myth 3: You Cannot Code for Ovarian Cancer Genetic Counseling

Again, there may not be one specific code for this in ICD-10-CM, but one CPT^® code, 96040 (Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family), enables you to capture the medical necessity for the service. In this case, to accompany the CPT^® codes, attach a more general ICD-10-CM code for genetic counseling: Z71.83 (Encounter for nonprocreative genetic counseling). And, if applicable, you might also use Z80.41 (Family history of malignant neoplasm of ovary).

How to document genetic counseling correctly: First, “a trained nonphysician genetic counselor must provide the service as described by 96040,” advises Leah Fuller, CPC, COC, senior consultant, Pinnacle Enterprise Risk Consulting Services LLC, Centennial, Colorado. If a physician or other qualified healthcare professional (QHP) who may report evaluation and management (E/M) services provides the counseling in an outpatient setting, you should use an E/M code from 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient …), Fuller adds. You can also use 99078 (Physician or other qualified health care professional qualified by education, training, licensure/ regulation (when applicable) educational services rendered to patients in a group setting …) if the provider offers the counseling in a group setting. “This can be reported for each patient involved,” Fuller notes.

Second, “per CPT^® guidelines, you cannot report 96040 for 15 minutes or less of face-to-face counseling time,” Fuller cautions.

Myth 4: Use Z51.11 for Patients Evaluated in the Office Before Receiving Outpatient Chemotherapy

This is not so much a myth as incorrect coding. You should use ICD-10-CM code Z51.11 (Encounter for antineoplastic chemotherapy) when the patient actually receives treatment. So, the infusion center would use the code as a primary diagnosis to bill for chemotherapy administration, followed by a code for the condition requiring care.

“For the provider evaluating a patient prior to chemotherapy, the correct code to use is Z01.818 (Encounter for other preprocedural examination) which includes ‘Encounter for examinations prior to antineoplastic chemotherapy’ under the descriptor as an example of an appropriate use of the code,” Fuller notes.

Myth 5: You Use Z85.43 When a Patient Stops Receiving Treatment