Code selection help!!!

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Hello,

I have a physician that documented, "Patients' chronic kidney disease is secondary to a combination of loss of renal mass secondary to nephrectomy."

He is billing for 753.0 which is a congenital absence of the kidney. I don't believe that is right. I did look into the ICD-9 book but could not find a code to better fit the situation.

Any ideas out there???

Thank you!

GeminiCoder74
 

btadlock1

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His first sentence doesn't make a lot of sense to me - Let me see if I can re-word it correctly: Is he saying that the kidney disease was caused by a loss of renal mass, which is due to a nephrectomy? The use of the words "combination of" is what's throwing me off - it makes me think that 2 different things should be impacting the situation in separate ways, not that one is the cause of the other - so I'd need to have clarification on whether the nephrectomy and loss of renal mass are related to each other or not, if I were in your shoes.

You're right about the code selection not sounding correct - A nephrectomy is the surgical removal of the kidney, which wouldn't be possible if it were congenitally absent. The doctor's code selection is contradicting his "findings" notes.
 

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His first sentence doesn't make a lot of sense to me - Let me see if I can re-word it correctly: Is he saying that the kidney disease was caused by a loss of renal mass, which is due to a nephrectomy? The use of the words "combination of" is what's throwing me off - it makes me think that 2 different things should be impacting the situation in separate ways, not that one is the cause of the other - so I'd need to have clarification on whether the nephrectomy and loss of renal mass are related to each other or not, if I were in your shoes.

You're right about the code selection not sounding correct - A nephrectomy is the surgical removal of the kidney, which wouldn't be possible if it were congenitally absent. The doctor's code selection is contradicting his "findings" notes.
Hi Brandi,

Per his HPI this is what he's reasoning is, "Patient had recurrence of the left distal ureter and he underwent left "ureteral nephrectomy", which showed infiltrating grade 3 carcinoma. The tumor also infiltrated left kidney with microscopic foci and negative margins."

I hope this additional information helps. I am thinking learning more toward a V code in this scenario.

Thanks!

GeminiCoder74
 

btadlock1

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Hmm...now I'm even more curious. So the cancer is gone, or has it moved to a secondary site? I'd probably need to see the whole note to give you an actual answer - it's hard for me to get an idea of what's going on. Why is the patient being seen, and what did the doctor decide to do? (Is this a check-up or is there a problem?):confused:
 

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Ok Brandi here it goes..HPI

67 year old male with history of recurrent transitional cell cancer of the bladder and ureter. The patient ultimately had symptoms in May 1993 and was treated by Dr. John Doe with resection and thiotepa. Later he had recurrence in 1995 and again in 1998 and he was treated by Dr. ABC with BCG to which he had a bad reaction. Later he had a radical cystoprostatectomy with ileal bladder by Dr. DEF in December 2000. The bladder and prostate showed transitional cell cancer in situ with transitional cell carcinoma of insitu of the left distal ureter orgin. Later I believe in 2006 he had a recurrence of the left distal ureter and he underwent left ureteral nephrectomy, which showed infiltrating grade 3 carcinoma. The tumor also infiltrated left kidney with microscopic foci and negative margins. So he also underwent adjuvant chemotherapy of gemzar and cisplatin. He developed right arm deep vein thrombosis in 2006. He was treated with Coumadin and it was discontinued. Currently his urine cytology is negative. Cystoscopy from March 2009 by Dr. 123 is negative. Urine cytology is negative. CAT scan from August 2010 is negative.


There is no mention that the patient is currently under chemotherapy...
 

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Ok Brandi here it goes..HPI

67 year old male with history of recurrent transitional cell cancer of the bladder and ureter. The patient ultimately had symptoms in May 1993 and was treated by Dr. John Doe with resection and thiotepa. Later he had recurrence in 1995 and again in 1998 and he was treated by Dr. ABC with BCG to which he had a bad reaction. Later he had a radical cystoprostatectomy with ileal bladder by Dr. DEF in December 2000. The bladder and prostate showed transitional cell cancer in situ with transitional cell carcinoma of insitu of the left distal ureter orgin. Later I believe in 2006 he had a recurrence of the left distal ureter and he underwent left ureteral nephrectomy, which showed infiltrating grade 3 carcinoma. The tumor also infiltrated left kidney with microscopic foci and negative margins. So he also underwent adjuvant chemotherapy of gemzar and cisplatin. He developed right arm deep vein thrombosis in 2006. He was treated with Coumadin and it was discontinued. Currently his urine cytology is negative. Cystoscopy from March 2009 by Dr. 123 is negative. Urine cytology is negative. CAT scan from August 2010 is negative.


There is no mention that the patient is currently under chemotherapy...

This is an office follow up...for creatinine increase
 

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Thank you for the last response, I truly appreciate it. However, I just needed a specific ICD-9 code for the scenario I posted earlier. A better ICD-9 code that the physician billed for or a V-Code?
 

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Based on that - V-code. Check the ICD-9 conventions for personal history of malignant neoplasm - they say something along the lines of : assign a personal history code when the primary malignancy has been eradicated and no further treatment is being directed at it, and assign a diagnosis if there are current signs/symptoms. It's much more decriptive than I just made it sound - I believe if you look under the specific chapter conventions for Neoplasms, and under the V-Code chapter under history of, aftercare, and follow-up, you'll find everything you need. ;)
 

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Based on that - V-code. Check the ICD-9 conventions for personal history of malignant neoplasm - they say something along the lines of : assign a personal history code when the primary malignancy has been eradicated and no further treatment is being directed at it, and assign a diagnosis if there are current signs/symptoms. It's much more decriptive than I just made it sound - I believe if you look under the specific chapter conventions for Neoplasms, and under the V-Code chapter under history of, aftercare, and follow-up, you'll find everything you need. ;)
Thank you Brandi, I will research it a little more...:)
 
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