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For other articles and previous issues click here. March 14, 2005 Coding
for Colon Cancer Colon cancer, which is the second-leading cause of cancer-related deaths in the United States, may begin as small, benign adenomatous polyps. Over time, the polyps become cancerous. Different types of colon polyps include the following: • Adenomas • Hyperplastic polyps • Inflammatory polyps • Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If left untreated, there is a high risk for the patient to develop colon cancer. • Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer. Benign polyps of the colon are classified to ICD-9-CM code 211.3, Benign neoplasm of colon. Malignant neoplasm of the colon is assigned to category 153. The fourth digit identifies the location of the neoplasm in the colon as follows: • 153.0 — Hepatic flexure • 153.1 — Transverse colon • 153.2 — Descending colon • 153.3 — Sigmoid colon • 153.4 — Cecum • 153.5 — Appendix • 153.6 — Ascending colon • 153.7 — Splenic flexure • 153.8 — Other specified sites of large
intestine. Includes malignant neoplasm of • 153.9 — Colon, unspecified If the rectum is included with the colon cancer, then assign code 154.0, Malignant neoplasm of rectosigmoid junction. Signs and Symptoms • Change in bowel habits • Blood in stool • Diarrhea, constipation, or feeling that the bowel does not empty completely • Pencil-thin stools • Persistent cramping • Gas pains, bloating, or fullness • Abdominal pain • Unexplained weight loss Symptoms may be caused by other conditions such as the following: • Inflammatory bowel disease (558.9) • Irritable bowel syndrome (564.1) • Diverticulosis (562.10 without mention of hemorrhage or 562.12 with hemorrhage) • Diverticulitis (562.11 without mention of hemorrhage or 562.13 with hemorrhage) Diagnosis • Digital rectal exam • Fecal occult blood test • Flexible sigmoidoscopy • Barium enema • Colonoscopy (45.23) — the physician may take a biopsy (45.25) or polypectomy (45.42) through the colonoscope • Virtual colonoscopy (88.01) — computerized tomography scan of colon Staging • Stage 0 — cancer has not grown beyond the inner layer (mucosa) of the colon. Also called carcinoma in situ (230.3) • Stage 1 — cancer has grown through the mucosa into the middle layer but hasn’t spread through the colon wall • Stage 2 — the cancer has grown through the wall of the colon but hasn’t spread to regional lymph nodes • Stage 3 — cancer has spread to any number of regional lymph nodes but not to other parts of the body • Stage 4 — cancer has spread to distant sites such as the liver, lung, or ovary • Recurrent — cancer has come back after treatment Treatment If the surgeon can’t perform the anastomosis, then a permanent or temporary colostomy will be done. Assign an additional procedure code for the colostomy performed unless an anterior resection of the rectum or abdominoperineal resection of rectum was performed. Codes 48.5 and 48.62 include a synchronous colostomy. Chemotherapy and radiation therapy may be used in combination with the surgical removal of the colon cancer. Coding and sequencing for colon cancer are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, and Vicki Sippel, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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