Hierarchical Condition Category Coding – CANCER Since This Is An Add On Course, The Prerequisite Courses Should Be Done First. The Prerequisite Course Will Give The Basic Information Needed To Be Able To Get The More Pertinent And Detailed Information Based On Different Diagnosis From This Course.
Hierarchical Condition Category Coding – CANCER
This course is for HCC (hierarchical condition category) Coding and Cancer Documentation. History of Cancer. Wrap it up. What do we know now?
Hierarchical Condition Category Coding – CANCER
Learning Objectives Understand the basics of HCC cancer coding, risk and how it impacts clinicians. Identify how to make HCC coding less confusing.
Gain a better understanding of documentation needed for ICD-10 coding.
Hierarchical Condition Category Coding – CANCER
Acronyms HCC - The Hierarchical Condition Category is a diagnosis grouping with a single relative factor assigned to it for each model segment. RAF - Risk Adjustment Factor.
PMH – Past Medical History. M.E.A.T. – Monitored, Evaluated, Assessed, or Treated. CMS – Centers for Medicare and Medicaid Services.
Documentation – The Key to it All!
Documentation – The Key to it All! Documenting is the key to it all. We know this can be an intimidating task. By applying the principles, you will learn in this short, but informative lesson, you can rest assured that you will be on the right track!
Let’s Expand one's scope of thinking during patient evaluation to include specific documentation verbiage for appropriate ICD-10 code. By using a clinical perspective to simplify the documentation specificity required to generate valid 3-7 character codes under ICD-10. Also, it’s important to recognize the importance of accurately documenting any associated diagnoses or conditions that impact care of current condition, decision making, treatment or management. Documentation that supports the cancer diagnosis and will protect your practice and its revenue.
General Documentation and coding guidelines are: The documentation must support the code selected and substantiate that proper coding guidelines were followed.
Documentation Requirements for ICD-10-CM Code capture. CMS Ruling: Use of Problem Lists.
The documentation must support the code selected and substantiate that proper coding guidelines were followed Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s)(I ICD 10). Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment or management. Do not code conditions that were previously treated and no longer exist. History codes (ICD-10:Z80-Z87) personal and family history codes) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment. (J ICD 10).
Documentation Requirements for ICD10-CM Code capture Under the official ICD-10-CM Coding Guidelines, a diagnosis can only be coded when it is explicitly spelled out in the medical record All documentation used for coding must be specific Super-bills, encounter forms and referrals are not acceptable forms of documentation. CMS does not recognize superbills as an extension of your documentation. These forms are simply a billing tool to capture services provided for a specific encounter.
Documentation Requirements for ICD10-CM Code capture For CMS’ risk adjustment data validation purposes, an acceptable problem list must be comprehensive and show evaluation and treatment for each condition that relates to an ICD-9/ICD-10 code on the date of service. It must be signed and dated by the physician or physician extender (NP, PA).
Don’t forget your M.E.A.T.:
Monitor
Evaluate
Asses/Address
Treat
Documentation – The Key to it All! When you are dealing with patients who have cancer, it is important to understand how to accurately document a cancer diagnosis. The surest way to document a cancer diagnosis is by having all of the following information in the patient’s medical records, and keeping consistent with the basic documentation guidelines already set out for you. The first thing that you must document is the Location of the cancer. Location – Anatomic part of the body – Where is the cancer located?.
When Documenting the location of the cancer, do remember to add any overlapping site boundaries and; any multiple non-contiguous sites in the same location.
Document by type, site and metastases of neoplasm Keep in mind, when documenting, what the ICD-10 code states, this will help you when documenting. As you read the codes below, note the information you would need to know to complete the code to it’s highest specificity some examples are: C18. _ Malignant neoplasm of colon (EXCLUDES malignant carcinoids) Specify site (cecum, appendix, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid, overlapping sites, or unspecified). C77.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes. HCC 8 Metastatic Cancer and Acute Leukemia Is the highest weighted HCC, approximate RAF of 2.6. ď ą Sickest patients, the most resources anticipated to be utilized.
Type of lesion Histology or cell type if known
Behavior – document all that apply Primary – cancer that arises from the cells found where the surgeon biopsies the neoplasm. Secondary/Metastatic – Cancer cells originated elsewhere and spread to this location. Documentation should clearly indicate the primary cancer and location of metastasis. In situ – Malignancy confined to the site of origin without invasion of neighboring tissues. Document by type of neoplasm, site and metastases Malignant primary
Benign
Malignant secondary
Uncertain behavior (path report) Unspecified
Ca in situ
From: Index and Table of Neoplasms in 2017 ICD-10-CM code book. If outpatient, can’t code diagnosis if documented as “possible”, “probable”, “consistent with”, “rule out”, or differential dx. Outpatient “working diagnosis” is coded as signs or symptoms until diagnosis confirmed.
Treatment What is being done to eradicate the cancer, is it targeting the primary or secondary malignancy, any associated complications. Chemotherapy. Radiation therapy. Immunotherapy. Surgical intervention.
Brachytherapy. Patient declines or is unable to have treatment.
Cancer Document: Site of primary and metastatic cancer, if known. Grade, stage, and morphology if available. Note: pathology report required to confirm morphology of surgical specimens, otherwise coded as unspecified. Acute/Chronic / or in remission status. Leukemia, lymphoma, multiple myeloma- risk adjust (HCC) indefinitely even if in remission if assessed and documented in chart every year. Update your medical record when more specific diagnoses become available!
Cancer Surveillance after treatment is not active treatment (i.e. colonoscopy after excision of colon CA). Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm. Z85.03_ Personal history of malignant neoplasm of large intestine. Medical conditions are hierarchically weighted within HCC categories, here are some examples in descending order of RAF values. HCC 8 Metastatic Cancer and Acute Leukemia (RAF approx. +2.6).
HCC 27 End-Stage Liver Disease (approx. +1.1). Lung and Other Severe Cancers (RAF approx. + 0.95). Lymphoma and other Cancers (approx. + .68).
History of Cancer – just a few other things!
History of Cancer - just a few other things! Almost all diagnosed ACTIVE cancers are associated with hierarchical condition category code (HCC). However, “history of� cancer is not associated with a HCC. So, it is important that cancer is documented and coding accurately following the ICD-10 guidelines.
History of Cancer – just a few other things! When diagnosing cancer, consider whether the cancer is active or the patient has a history of cancer: “Active” cancer – Indicates a current, active diagnosis of cancer when any of the following exist: The patient has evidence of current disease. The patient is receiving treatment for cancer. This includes current or long term therapies. The patient did not receive definitive treatment for their malignancy. “History of” cancer – The patient has successfully completed treatment for malignancy, has no current treatment for the condition and no evidence of the disease.
History of Cancer – just a few other things! Beware of how PMH (past medical history) is used in documentation! Cancer: Is it active, under treatment, in remission, or is it really PMH? Active malignancy is HCC (excludes most skin CA and in-situ tumors except melanoma).
Document malignancy is active and address treatment, even if being treated by specialist. Active treatment includes Tamoxifen or Lupron. Malignancy is still active if cancer present but patient declines treatment or is being observed (i.e. prostate CA).
If excised/eradicated and no further tx and no evidence of residual tumor, it is PMH (cured) - not an HCC.
Wrap It up!
Wrap It up! Document, document, document! Make sure you mention, location, type of lesion, behavior and treatment when coding for a cancer diagnosis. This allows for you to get to the higher RAF values, also to capture that diagnosis for a more appropriate reimbursement.
Update your medical record when more specific diagnoses become available!!! Make sure you know when PMH should be coded and addressed..
What do we know now?