Question Lymphoma Stage 4 w/ metastasis to the bone.

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For Risk Adjustment Coding, this was the information given in the Assessment. Please assume it's a complete record, there is no way we can query the provider and no other info provided in other sections of the chart.

Lymphoma stage 4 with metastasis to bone. Completed Raloxifene treatment. Radiation to the left rib completed last week. There is a lesion on rib not treated and to be monitored.

How do we code this example?
 
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trarut

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As I was always taught, lymphoma does not metastasize, it merely presents in a new area so you code whatever area of disease is currently active (or is being treated). Has the rib lesion in question been definitively identified as lymphoma or is it a bone lesion that they are watching to see if it changes in behavior? If they did not treat that lesion with radiation, I would say it's not confirmed as lymphoma so they don't want to irradiate it.

I would query the provider for clarification on the untreated bone lesion. Since you state that isn't an option, I would code the lymphoma for the current active site (the one just irradiated) and code the other lesion as a bone lesion since it's not indicated to be otherwise. (If it was lymphoma, I would expect it to have been treated during the radiation.)
 
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