AHA Coding Clinic® for ICD-9 - 2006 Issue 1; Ask the Editor

Possible or Probable Malignancy

A patient was admitted after being seen in her physician’s office complaining of a six-month history of weakness, fatigue, decreased intake by mouth, and a 30-pound loss of weight. Hepatomegaly and jaundice are found on physical examination. CT of the chest and abdomen are compatible with extensive metastatic disease involving the lungs, liver and intra-abdominal lymph nodes. A primary tumor was not identified with certainty although the possibility of a pancreatic mass was considered. Discharge diagnoses included liver and lung masses, probably metastatic disease. How should this admission be coded?It is our understanding that some hospitals follow the Guideline for Uncertain Diagnoses, while others assign malignancy codes only upon confirmation by the physician. The implications inherent to a cancer diagnosis (based on the guideline and without the physician’s confirmation) warrant consideration due to potential insurance denials, unwarranted contact by tumor registry and collection of inaccurate data. We ask that the Cooperating Parties consider making cases of unconfirmed malignancies be an exception to Guideline II-H, just like cases of HIV infection. ...

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