Coding Diagnoses in Patients Treated Successfully for Malignancy

The ultimate goal of cancer therapy to complete remove or eradicate a malignant tumor. Patients who no longer have signs of a malignancy may still require ongoing maintenance therapies related to the cancer or may need future care unrelated to the cancers. Providers need to know how to code the appropriate diagnosis code.

The correct approach to coding is contained in the ICD-9-CM 2008 Coding Guidelines in the chapter specific coding guideslines for Neoplasms (Section 1.C.2) . If therapy is directed at a malignancy, past or present, the malignancy should be the primary diagnosis code. If a malignancy has been completely excised or eradicated, the appropriate supplemental code in the V10 series that denotes a Personal History of Malignant Neoplasm may be used as a secondary diagnosis. Some payers may require the V10 code in addition to the primary.

NPI Dates and Edits for Medicare Providers

Effective March 1, 2008, providers must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields) on Medicare fee-for-service professional claims. They may continue to submit NPI/legacy pairs in these fields or submit only the NPI on the claim but may not submit claims containing only a legacy identifier in the primary fields.

Medicare previously required a unique physician identification number (UPIN) be reported on claims for any ordering, referring/attending, operating, other, and service facility providers (i.e., or for any provider that is not a billing, pay-to, or rendering provider). Effective May 23, 2008, the identifier for such a provider must be an NPI, regardless of whether the provider is a covered entity, or participates in the Medicare program. Therefore, Medicare will not pay for referred or ordered services, or items, unless the name and NPI number of the ordering, referring and attending, operating, other, or service facility provider are on the claim.

Providers should be aware that it is the claim/bill submitter's responsibility to obtain the ordering, referring and attending, operating, other, service facility providers, or purchased service providers' NPIs on the claim.

Some providers are currently receiving electronic media claim (EMC) informational edits triggered because there is a legacy number (like PTAN, Medicare PIN, or Medicare Provider Number) or UPIN on the claim. Currently these are just informational for the provider, however, claims will start to reject on May 23rd if NPIs are not used.

Dr. Carter's Corner
Darren Carter, MD, founder and President of Provistas, has a personal commitment to alleviating uncertainties in the new health compliance environment. He has authored dozens of articles, presents to professional and hospital associations, serves on several editorial boards, and provides consulting and expert witness testimony.