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Lung cancer diagnosis

  1. #1
    Question Lung cancer diagnosis
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    I have a question about using the lung cancer diagnosis. How does one differentiate if the lung cancer is small cell, squamous cell, adenocarcinoma or large cell only by choosing the code 162.x ? 162.x only allows for choice of location, but not classification. Any thoughts would be helpful. Thanks

  2. #2
    Columbia, MO
    For the dx code you do not worry about the morphology of the cancer just the location. The only exception being melanoma.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    I think for lung cancer diagnosis need to check the part of the lobe(upper/lower) is affected, 162.X....otherwise use 162.9 for lung cancer.

    Nalini CPC

  4. #4
    My concern here is morphology does matter when I code for a PET scan. Medicare will pay for an initial scan but not a subsequent scan on a patient with small cell lung cancer. Im not sure how Medicare knows to classify lung cancer as "small cell" when only the code 162.9 is used?

  5. #5
    Columbia, MO
    The morphology cannot be coded, and I have never heard of Medicare restricting medical necessity based on Morphology. Do you have that in writing from Medicare or is it something someone told you. I have never had an issue with reimbursement for the subsequent scan. If the cancer is no longer active and this scan is to check for recurrence or staging then you would use a hx of V10.x code. If the cancer is still active and is undergoeing treatment and the Pet scan is for staging purposes then you use the 162.9. The M codes for the morphology are never used for claims but will be used by the persons in tumor registry. Again check the LCD/NCD again if that is where your infor on the medical necessity is comming from.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    I have never heard of Medicare denial based on Morphology either. The only PET denials I am aware of are for frequency, as there are limitations regardless of the Neoplasm or Morphology.

    Lisa Bates

  7. Default
    Libra, one of our precert girls asked us coders about this the other day SO your not crazy, it did come from some where, but her telling us about it was the first we heard. Was it on Medicare website or something? BUT it is true, all we have to choose from is location, so not too sure what Medicare expects us billers to do!!

    Amanda, CPC
    Urology coder

  8. #8
    Thanks Amanda. I guess what I am trying to say when I meant "morphology" is the classification of the lung ca. Is it small, non-small, adenocarcinoma, etc. With that said, Medicare will cover for an initial scan on the code 162.9. However, on a subsequent scan, it is NOT covered (if its small cell) and then requires an NOPR. I wanted to know how one determines what kind of lung cancer it is with just the code 162.9.

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