Question HCC query – prostate cancer

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Prostate cancer is mentioned in the Assessment. But there is no MEAT found in the report to validate the diagnosis of prostate cancer (no evidence found in the current medication list). In the lab, the prostate level was elevated.

Can we code prostate cancer? Is elevated prostate level enough to code prostate cancer? Can we code prostate cancer directly since it is mentioned in the Assessment?

Thanks in advance for any help/advice.
 

sls314

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Local Chapter Officer
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Toledo, OH
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For this scenario, I'm assuming that the HCC project doesn't have specific rules about what the project will accept as MEAT for prostate cancer. (Otherwise, I'd follow the project rules.)

However, in general, I would not accept just an elevated PSA as evidence of current prostate cancer.

I'd want to see that there was active treatment - chemotherapy, radiation, adjuvant hormonal therapies, plans for future prostate surgery, etc. Or that the patient was declining treatment. (Ex. - the cancer is still active even if the patient refuses chemotherapy)

Prostate cancer is one I see come up a lot where the provider says "prostate cancer" but it's really "history of prostate cancer". I've seen charts where the surgical history says that the patient had a radical prostatectomy 10 years ago and there's absolutely no mention of current treatment or monitoring, but the provider still mentions "prostate cancer." Nope.

It needs to be REALLY clear to me that the cancer is current before I pick it up for risk adjustment purposes. (Unless my project specifications tell me otherwise.)
 

BAM1255

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Agree with Susan's comments. And elevated PSA alone is not evidence of current prostate cancer. Patient can have elevated PSA with a PIRADS 1 & 2, etc.
 

dparham

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I agree with all of the above but would add, that even without treatment but the provider add in the assessment the words "watchful waiting, active surveillance by Oncology or Urology", then it is still active, e.g. these other specialists are still waiting for some other tests results or some other reason to be absolutely sure that there is no more cancer and not recurrent.
 
Messages
39
Best answers
0
For this scenario, I'm assuming that the HCC project doesn't have specific rules about what the project will accept as MEAT for prostate cancer. (Otherwise, I'd follow the project rules.)

However, in general, I would not accept just an elevated PSA as evidence of current prostate cancer.

I'd want to see that there was active treatment - chemotherapy, radiation, adjuvant hormonal therapies, plans for future prostate surgery, etc. Or that the patient was declining treatment. (Ex. - the cancer is still active even if the patient refuses chemotherapy)

Prostate cancer is one I see come up a lot where the provider says "prostate cancer" but it's really "history of prostate cancer". I've seen charts where the surgical history says that the patient had a radical prostatectomy 10 years ago and there's absolutely no mention of current treatment or monitoring, but the provider still mentions "prostate cancer." Nope.

It needs to be REALLY clear to me that the cancer is current before I pick it up for risk adjustment purposes. (Unless my project specifications tell me otherwise.)
Thank you
 
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