Wiki Patient with history of nasopharyngeal cancer comes for laryngoscopy

[ljones88]

Hi,

I searched the threads and couldn't find a thread related to my issue. An established patient with a history of nasopharyngeal cancer is seen in the office for a laryngoscopy. Physician also documents an E/M and removed impacted cerumen from the ears. Patient completed chemo and radiation therapy about a year ago and the physician has the patient come in every 6 months now for cancer surveillance. Since the patient doesn't have any symptoms other than a dry throat, and no evidence of disease, I'm having a hard time figuring out what diagnosis code to use for 31575. Both Z codes, Z85.818 and Z08, are falling into an LCD edit as not meeting medical necessity...

So would I bill just the E/M and 69210 and forgo billing 31575 since I have no other dx that can be billed with 31575???

 

[thomas7331]

What LCD is giving you trouble? I've never run into a problem with the laryngoscopy requiring a specific diagnosis. On a side note, there's a distinction between 'no evidence of disease' and 'history of cancer'. A patient may still carry the cancer diagnosis but have no evidence of disease, so I wouldn't necessarily use a history code unless the physician has specified that the patient is cancer free and in remission. But even so, the cancer diagnosis alone should not be necessary to meet medical necessity for the procedure.

 

[ljones88]

Thank you for clarification on the distinction between the two. I had figured if there was no evidence of disease, the cancer was in remission. However, since our physician has not documented that the cancer is in remission I coded with the cancer dx C11.9. We use Code Correct for most of our code edit concerns and when entering 31575 with either one of the Z diagnosis codes, we would get a red box indicating that an LCD edit was in place with that code pair and may result in a claim denial, however with C11.9 there was no edit invoked.

 

[mitchellde]

If the provider documents no evidence of disease and there is no further treatment directed to the cancer then it is history of the cancer. You should not code with the code for the neoplasm even if that is the code that "gets the service paid". Cancers like breast cancer are often documented as no evidence of diseas however they are still being treated with Tamoxifen, so it is correct to code active breast cancer. Often we had patients that had one more round of chemo to go and the provider would document no evidence of disease, but they were still undergoing chemo so it was appropriate to code this as active cancer. In your scenario the patient has no evidence of disease and no further treatment, so it is not appropriate to code this as active cancer. You should use the Z codes.