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Gemcitabine

T

Tonyj

True Blue
Messages
649
Location
Lithonia, GA
I'm getting a denial from Medicare for use of gemcitabine for chemotherapy due to the fact that the patient has colon cancer. 1 of the uses for Gemcitabine is sarcoma which in this case the patient has sarcoma of the colon. We have sent in path reports with the documentation for sarcoma of the colon and have still gotten denied. What could be my next course of action?
 
That is for primary site malignancy of the colon. You need to check with the doc but sarcoma is a bone cancer and if it is in the colon then it is metastatic. So you need a primary bone cancer code 170.9 if you do not know the site, and the mets to the colon 197.5 you would list the 197.5 first.
 
mitchellde said:
That is for primary site malignancy of the colon. You need to check with the doc but sarcoma is a bone cancer and if it is in the colon then it is metastatic. So you need a primary bone cancer code 170.9 if you do not know the site, and the mets to the colon 197.5 you would list the 197.5 first.
Click to expand...

Sarcoma is not primarily bone cancer but can also be of the soft tissue. Path report states "high grade sarcoma predominantly undifferentiated with round cell morphology." Patient also has liver and lymph node metastisis

Should I use 171.9 primary? Path report sent in to Medicare also.
 
If you do not know the origin of the sarcoma then you could go with then171.9 but the colon is a metastatic site and needs to be coded as metastatic, also code the other metastatic sites, but since the colon is what is being treated then code it first listed. Most of the time the Medicare reviewers will not review a path report unless it is specifically requested.
 
mitchellde said:
If you do not know the origin of the sarcoma then you could go with then171.9 but the colon is a metastatic site and needs to be coded as metastatic, also code the other metastatic sites, but since the colon is what is being treated then code it first listed. Most of the time the Medicare reviewers will not review a path report unless it is specifically requested.
Click to expand...

Thanks much Debra! We'll give it a shot.
 
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