Oncology & Hematology Coding Alert

 Don't count on the ICD-9 neoplasm table to hold all the answers If you code for an oncology practice, you're coding neoplasms - a challenge that demands in-depth knowledge for accurate coding. Follow our quick guide to help keep denials at bay. 1. Bide Your Time for the Path Report "Without the pathology report, you're just guessing what kind of neoplasm you're dealing with," says Mary I. Falbo, MBA, CPC, president of Millennium Healthcare Consulting in Lansdale, Pa. Even if the ordering physician has a strong suspicion that the growth is cancerous, for instance, the diagnosis is still unconfirmed until you get the pathology results.
 
Never code based on a "suspected" or "rule-out" diagnosis that the ordering physician may submit, agrees MaryAnn Luick, CPC, CCP, with the UPMC Cancer Pavilion in Pittsburgh. And remember, a mass is not the same as a neoplasm, she says.
 
Bottom line: Choosing a diagnosis is hard enough, so be sure you have all the relevant information before you proceed. 2. Pinpoint the Type of Neoplasm With the pathology report in hand, first determine if the neoplasm is benign or malignant. If it's malignant, you'll have to identify the type: primary, secondary, or     in situ (see "Glide Through Neoplasm Coding With This At-a-Glance Glossary" on page 60 for more on the different types of neoplasms). 
 
The pathology report usually identifies the type of neoplasm. Snag: Reading path reports can be very tricky, says Beth Potratz, CPC-A, with The Cancer Treatment Center in Swansea, Ill. Clarify any questions you have about wording before you move on to the next step. 3. Check With ICD-9 Volume 2 Next, you should go to the alphabetic index (volume 2) of the ICD-9 manual and look up the main term that describes the neoplasm type, such as melanoma, lymphoma, or adenocarcinoma. 
  
Don't skip to the neoplasm table: Although the alphabetic index will often direct you to the neoplasm table, checking the index is not a wasted step. Some conditions are only listed in the index, and sometimes using the index simply saves time.
  
Example: If you look up "melanoma (malignant), lip" in the alphabetical index, you will find 172.0 (Malignant melanoma of skin; lip). But if you had started with the neoplasm table, you might have looked up "lip" and chosen 140.9 (Malignant neoplasm of lip, unspecified, vermilion border). Or you might have looked up "skin, lip" and chosen 173.0 (Other malignant neoplasm of skin; skin of lip) in error. 4. Advance to the Neoplasm Table If the alphabetical index doesn't provide the information you need, you should next consult the neoplasm table.
  
Example: A patient may exhibit malignant mesothelioma. If you find this term in the ICD-9 index,
the entry will direct you [...]