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Cancer coding primary vs. secondary - My confusion.

  1. Question Cancer coding primary vs. secondary - My confusion.
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    I haven't coded cancer for a practice before, as I'm usually coding for pain management, but these scenarios are subsequent hospital visits billing for physician visits. Below are the physician's ENTIRE dictation at each encounter, but I'm ONLY confused as to what I am coding for the CANCER. *No need to spend your time coding the others for me, thank you *

    The patient with "Assessment A" had been previously coded by another coder at admit as C61- Malignant neoplasm of prostate ... I'm interpreting the following assessment as C79.82- Secondary malignant neoplasm of genital organ.

    My general understanding of prostate cancer is that it will begin at the prostate and metastasize elsewhere (the spine, bones, etc.). My confusion is: Is "Metastatic prostate cancer" saying the prostate cancer is spreading elsewhere (as primary), or that the prostate cancer itself is metastatic (secondary).

    I have other examples as well that have seemed to confuse me a bit. Can someone please advise on how I should read the cancer dictation, and possibly how to code these encounters for the cancer?

    ASSESSMENT A:
    1. Metastatic prostate cancer.
    2. Thoracic spinal cord compression with metastatic prostate cancer status post laminectomy and fusion.
    3. Incomplete paraparesis.
    4. Neurogenic bladder.
    5. Neurogenic bowel.
    6. Leukocytosis.


    ASSESSMENT B:
    1. Incomplete quadriparesis secondary to metastatic prostate cancer of the thoracic spine.
    2. T2-T5 laminectomy for excision of metastases with focal fusion.
    3. Widely metastatic prostate cancer to the bone.
    4. Dyslipidemia.
    5. Neurogenic bladder.
    6. Neurogenic bowel


    ASSESSMENT C:
    1. Metastatic renal cell carcinoma to the T10 vertebral body, status post laminectomy and spinal
    decompression.
    2. Postoperative epidural hematoma, status post evacuation.
    3. Neurogenic bladder.
    4. Neurogenic bowel.



    ANY help would be greatly appreciated, as I seem to have confused myself at this point.

    Thanks,

    -Erica

  2. Default
    Based on what you have posted, the prostatic cancer is primary and the spinal cancer is secondary

    You'd code first for what is being dealt with primarily at that visit, which means that in some cases, you would code the secondary cancer ahead of the primary cancer

    In your examples, I would code prostate only for A, spinal/prostate for B, and renal cell/spinal for C - but I would need to see the whole note to be 100% sure

  3. #3
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    I work and code for a facility based cancer center. We code the cancer that we are treating as primary with the others following. If we were treating the bone mets, it would be coded first followed by the prostate and other cancer codes. If we were treating the prostate, it would be coded first. At times they may be receiving radiation to the spine and chemo for the prostate, the primary is whatever we are treating that day.

    If I am coding for an office visit, I code the most recent metastatic site, followed by other mets and then the primary or history of code depending on the situation. In other words the most recent diagnosis first. If we are seeing the patient for a complication of treatment or of the cancer than the complication is coded first.

    Hope this helps.
    ____________________________________________
    Rhonda Crouch, CPC, CPMA, CHONC
    Billing Manager
    CRMC Cancer Center
    Phone: 931-267-5640
    rcrouch@crmchealth.org

    Cookeville TN AAPC Chapter President 2013, 2014, 2017
    Vice-President 2012, 2015

  4. #4
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    There is an old old coding clinic that really helps with this. It is he May/June 1985 if I remember correctly. With a statement such metastatic prostate cancer, you code the prostate as primary with an unknown secondary unless it is indicated. if it is a well known primary site such as prostate. If it said for instant metastatic bone cancer then the bone would be coded as the metastatic site with an unknown primary because bone cancer is more common as a metastatic than a primary. The coding clinic gave a list of those sites which are more common as a metastatic than a primary.
    For the first example you gave, there was no real indication of the metastatic site although I assume it was the bone but you would need more clear documentation so you would go with unknown secondary.

    Debra A. Mitchell, MSPH, CPC-H

  5. Thumbs up Very helpful
    Thank you all for your input, this was quite helpful!!

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