Advanced Search

Oncology & Hematology Coding Alert

You Be the Coder:

Coding for an Elevated CA-125

Published on Fri Jun 01, 2001

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: What is the correct way to code for an elevated CA-125? We have a patient who is being observed by the doctor for an elevated CA-125, but no other treatment is being done and the physicians dictation simply states her diagnosis as elevated CA-125. We have coded her visits as 796.4 (other abnormal clinical findings).

Oklahoma Subscriber


Answer: Code 796.4 is not correct, but the phrase elevated CA-125 is correct. CA-125 is an antibody found associated with the presence of tumor cells. Its level is assessed in the laboratory as a sample of the patients blood.

The correct code is 790.99 (other nonspecific findings on examination of blood), because it best describes the situation a blood test result without a specific known condition. If there is a specific condition stated in the medical record, remember to code that condition. For example, codes 251.2 (hypoglycemia), 276.7 (hyperkalemia), and 272.4 (hyperlipidemia) often accompany an elevated CA-125. An elevated CA-125 is often an indication of ovarian cancer (183.0).
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Oncology & Hematology Coding Alert

View All