Hospice patient

JEANNE.SNYDER@iroquoismemorial.comJEANNE.SNYDER@iroquoismemorial.com
in Home Care Coding General
Client has features suggestive of Metastatic disease. Unknown primary, no biopsies. Nodules in lung, pancreas, multiple blastic metastatic deposits in the spine. Client has ascites,and elevated CEA. MD calling it metastatic carcinoma, unknown primary. Can I code to that when it states nodules, and with no testing?

Comments

  • JEANNE.SNYDER@iroquoismemorial.comJEANNE.SNYDER@iroquoismemorial.com
    edited April 2017
    Correction elevated CA-125

    Jeanne Snyder RN
    Intake Coordinator IMH Home Health/Hospice
    200 North Laird Lane
    Watseka,Il. 60970
    815-432-6175/815-432-0185
    FAX 815-432-6199
    jeanne.snyder@iroquoismemorial.com
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    " MD calling it metastatic carcinoma"
    I would code the lung as lung mets, the pancreas as mets too, and the spine, mets as well. All unspecified sites.
    You can only code ascites, not metastatic ascites unless the physician has documented as being a cancer process fluid collection.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • JEANNE.SNYDER@iroquoismemorial.comJEANNE.SNYDER@iroquoismemorial.com
    edited April 2017
    Would you code Primary unknown? MD does have that in record.

    Jeanne Snyder RN
    Intake Coordinator IMH Home Health/Hospice
    200 North Laird Lane
    Watseka,Il. 60970
    815-432-6175/815-432-0185
    FAX 815-432-6199
    jeanne.snyder@iroquoismemorial.com
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Good question.
    I would not because the primary is unknown. How can you code something that is not known?

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • eharcourt@ecommunity.comeharcourt@ecommunity.com
    edited April 2017
    But there is a code for an unknown primary : C80.1 so that is what I would use. I am not sure that you can code a nodule as a mets unless the MD states that he believes it is. I would verify this MD.



    Thank you,
    Evelyn Harcourt HCS-D
    Data Entry/Coding Specialist
    621-4822
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Thank you Evelyn. I learn something new every day.
    Here's the coding tip:
    When coding a secondary site of the cancer and the primary site is unknown, C80.1 should be added for unknown primary site. A biopsy-proven malignancy for which a primary site cannot be found constitutes 0.5% to 7% of all cancer patients.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • JEANNE.SNYDER@iroquoismemorial.comJEANNE.SNYDER@iroquoismemorial.com
    edited April 2017
    Thank you Nancy and Evelyn I appreciate the help!!

    Jeanne Snyder RN
    Intake Coordinator IMH Home Health/Hospice
    200 North Laird Lane
    Watseka,Il. 60970
    815-432-6175/815-432-0185
    FAX 815-432-6199
    jeanne.snyder@iroquoismemorial.com
  • April.D.Brooks@comhs.orgApril.D.Brooks@comhs.org
    The hypertensive code should be sequenced before the CHF code like so: I13.0, I59.22, N18.x
  • April.D.Brooks@comhs.orgApril.D.Brooks@comhs.org
    The hypertensive code should be sequenced before the CHF code like so: I13.0, I50.22 (correction), N18.x (whichever stage)
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