HCC Coding for Providers – Oncology Guidelines

Confusion exists around when to code active cancer versus history of cancer, particularly when a cancer has been successfully treated but the patient continues to be followed for this problem.

ICD-10 guidelines stipulate the following:

“ When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any primary existing malignancy, a code from category Z85, a personal history of malignant neoplasm, should be used to indicate the former site” (Section I.C.Ch2.m)

Active treatment supporting active cancer coding includes:

  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Adjuvant hormonal therapies***A FREQUENT SOURCE OF MISCODING

If the patient opts for no treatment toward the malignancy or treatment is contraindicated, the provider must document as such in each encounter so the appropriate active cancer code can be assigned.

Coding examples:

Correct coding of active cancer diagnosis:

  • Low grade prostate cancer, patient opts for no treatment at this time. Will continue to monitor every 6 months for progression of disease. We will reassess treatment options at that time.
  • Splenic lymphoma, previously treated with rituximab. This is on hold due to vascular disease and non-healing foot ulcers. Plan is to continue aggressive wound care and consider restarting rituximab once ulcerations heal.

Correct coding of personal history of cancer diagnosis:

  • History of prostate cancer, status post radiation therapy 2016, asymptomatic with undetectable PSA. Continue yearly surveillance.

Source: ICD-10-CM The Official Guidelines for Coding and Reporting www.cdc.gov/nchs/icd10cm.htm; AHA Coding Clinic http://www.ahacentraloffice.org/ ; RISE Risk Adjustment Academy – HCC Coding Accuracy.