Wiki CA Dx - WTC Twin Towers Medical Plan

mwolpert

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Hello,
I have a patient who was involved in rescue efforts at the Twin Towers on 9/11. He subsequently developed cancer on his palate. The patient had surgery to remove the cancer, but this left a defect that needed surgery at a later date. That's where our plastic surgeon came into the picture. He repaired the defect in the palate with the diagnosis codes K13.79 Other lesions of oral mucosa, K13.29 Other disturbances of oral epithelium, including tongue, Z42.8 Encounter for other plastic/reconstruction surgery following medical procedure or healed injury, Z85.09 Personal history of malignant neoplasm of digestive organs. This payer will not accept any diagnosis other than the C05.1 Malignant neoplasm of soft palat, however, the cancer is not present anymore. It is my understanding that once the cancer is removed it cannot be coded anymore.

Thank you for any insight you can provide.
Mary
 
"Section 1.C.2 Provides Guidance
According to the ICD-10 guidelines, (Section I.C.2.m):

When a primary malignancy has been excised but further treatment, such as additional surgery for the malignancy, radiation therapy, or chemotherapy is directed to that site, the primary malignancy code should be used until treatment is complete.

When a primary malignancy has been excised or eradicated from its site, there is no further treatment (of the malignancy) directed to that site, and there is no evidence of any existing primary malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used to indicate the former site of the malignancy."


https://www.aapc.com/blog/40016-clear-up-confusion-as-to-when-cancer-becomes-history-of/


Hope someone with more experience chimes in.
 
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Dealt with this plan a few times quite a few years ago. I'd call them to discuss and add history dx if possible. Otherwise, you have to code causation of the injury/absence of organ by the cancer.
 
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