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February is National Cancer Prevention Month

Coding Educator, February 15, 2010

By: Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

Each day in the United States scientific research makes strides toward the ultimate goal for finding a cure for cancer. Despite the ongoing effort, new cases of this deadly disease are still emerging throughout the nation.

 
In 2009 alone, it is estimated that 1,479,350 new cases of cancer were diagnosed in the United States. While there is no definitive method for cancer prevention, there are ways to reduce the risk. This February during National Cancer Prevention Month, consider these choices and their potential impact they could have.
 
Cancer is defined as a group of diseases characterized by uncontrolled growth and spread of abnormal cells, and is caused by both external factors (infectious organisms, tobacco, chemicals, and radiation) and internal factors (inherited mutations, hormones, immune conditions, and mutations that occur from metabolism), according to the American Cancer Society.
 
Coding for cancer
 
Within the Alphabetic Index of ICD-9-CM is a Neoplasm table that assists coders in assigning diagnosis codes (Vols 1-2). The table is structured based off the specific location of the neoplasm as well as the type of neoplasm. There are four types of neoplasms on the neoplasm table:
  • Malignant
  • Benign
  • Uncertain Behavior
  • Unspecified
 Malignant neoplasms can be classified as either primary, secondary or carcinoma in situ. A primary malignant neoplasm is the originating site of the neoplasm and will remain the primary site even if the neoplasm spreads or invades other body areas. A secondary site or “metastasis” is where the primary neoplasm has spread to another site. Carcinoma in situ is generally a non-invasive malignant neoplasm. 
 
If the provider documents a histiological term to describe a neoplasm, it is always recommended to reference that term first to determine which column on the table should be used. For example, if a provider documents “oat cell carcinoma” you will see that the  ICD-9 coding manual has an instructional note to--See Neoplasm, by site, malignant and for unspecified sites it will default to a malignancy neoplasm of the lung (162.9).
 
Sequencing for neoplasms is generally assigned based off the reason for the encounter and/or the specific neoplasm being evaluated or treated. The site listed as the first-listed or principal diagnosis is the neoplasm being evaluated or treated during the current encounter/admission. Please note that this may be a secondary site. An exception to this rule would be if the sole purpose of the encounter was to receive treatment (e.g. radiation therapy or chemotherapy) then the first-listed or principal diagnosis would be either V58.0 or V58.1x respectively. Assign additional codes for the neoplasm(s) that were being treated. 
 
In instances where the patient is being seen for a metastatic site and the documentation states that the patient has an “unknown primary site,” assign code 199.1 (Malignancy, unspecified site).. 

I would put a subhead here now that you’re done with the coding piece or should it just go above and save the coding part for last like you usually do?

Certain factors that can lead to cancer, that are preventable include: cigarette smoking, excessive alcohol consumption, obesity, physical inactivity, poor nutrition and overexposure to the sun / indoor tanning. However, cancer prevention is not always going to be so cut-and-dry. Regular screening examinations from your physician can result in early detection and removal of precancerous growths, so it is important to have a heightened awareness of any irregularities or changes in your body. Cancers that can be prevented or detected early by these screens account for at least half of all new cancer cases.
 
Daily lifestyle choices can also have an impact on the likelihood of getting cancer. The American Institute for Cancer Research recommends a basic three-tier approach to begin with:
  1. Be physically active for at least 30 minutes a day
  2. Aim to be a healthy weight throughout your life
  3. Be careful of what you eat, and limit red meat and avoid processed meat
Visit the American Institute for Cancer Research here: http://www.aicr.org/site/PageServer

Visit the American Cancer Society here: http://www.cancer.org/docroot/home/index.asp

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