Download Molina Healthcare Coding Tips Cancer

Molina Healthcare Coding Tips
Cancer
What are the Common Diagnosis Categories for
Cancer Conditions?
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Metastatic Cancers & Acute Leukemia
Lung and Other Severe Cancers
Lymphoma and Other Cancers
Colorectal, Bladder, and Other Cancers
Breast, Prostate, and Other Cancers and Tumors
When are Cancer Conditions Considered
“Current” and “Active”?
Acceptable Documentation
Welcome to the Molina
Healthcare Coding Institute.
Molina Healthcare is committed to supporting
your clinical practice. Please take a moment to
review this HCC Pearl.
Coding cancers confuses many ambulatory
providers since there are nuances to cancer
coding based on whether the patient is actively
undergoing treatment for his or her condition.
In addition, in order to support a coding review,
documentation of a current treatment intervention
must be present in the note.
V-Codes are also known as Aftercare Codes. These
codes are reserved for patients with a history of
cancer not currently in treatment. Remember if
you use the term “History of ...,” then a V-Code
is required unless you have clearly stated in the
assessment and plan that treatment is ongoing.
The most common exception to using a VCode in the post-treatment setting is Leukemia
in remission (204.00 - 208.92).
Tip: Try not to rely solely on an Oncologist
when documenting a cancer condition. Obtain
reports from the Oncologist and update your
progress notes at each visit in order to fully
capture cancer diagnoses.
» Cancer conditions are “active” if the patient is currently being
treated for the condition
• 62 year Female with Breast Cancer currently on Tamoxifen
followed by Oncology. Assessment: Improving (Coded as 174.9,
provider documented the Cancer as being on actual treatment
for the condition and being treated by a specialist)
Plan: Continue current care
» If the patient refuses treatment then document:
• 45 yearoldmale withLung Cancer.
Assessment: Patient refusestreatment.(Coded as162.9, even though
member refusestreatment wecan still codethecondition asactiveas
long aslongas theproviderdocumentsthat treatment was refused)
Plan: Continue current care
• 52 year old female with chronic lymphocytic leukemia.
Assessment: Patient opted for no treatment. (Coded as 204.10,
even though member refuses treatment we can still code the
condition as active as long as long as the provider documents
that treatment was refused)
Plan: Encourage positive lifestyle choices and supportive care
Incomplete Documentation
» No treatment or indication of the cancer as being active
• 56 year old male with Prostate Cancer followed up by Urologist.
Assessment: Uncertain status (unable to code the cancer as
active, follow-ups can also be considered as just surveillance
for the condition)
Plan: No change
» CMS considers a patient cancer free if:
• The condition has been eradicated by surgery/ radiation/chemo,
or the patient has completed all treatment
» Use V-Codes when your documentation says:
• “History of ...” and no treatment is currently occurring
» Leukemia In Remission (204.00-208.92)
• May be coded as Current (i.e. No V-Codes)
Have Questions?
Contact: [email protected]