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October 30, 2006

Coding for Ovarian Cancer
For The Record
Vol. 18 No. 22 P.

Ovarian cancer is an abnormal growth of cells in an ovary. It is curable if diagnosed early, but the cancer is frequently advanced before it is detected because the symptoms often mimic other conditions.

The AHA Coding Clinic for ICD-9-CM code assignments for neoplasm of the ovary are as follows:

• Primary malignant — 183.0;

• Secondary malignant — 198.6;

• Carcinoma in situ — 233.3;

• Benign neoplasm — 220;

• Uncertain behavior — 236.2; and

• Unspecified — 239.5.

Symptoms
The consistent symptoms of ovarian cancer include the following:

• abdominal pressure, fullness, swelling, or bloating;

• urinary urgency; and

• pelvic discomfort or pain.

These symptoms are persistent and worsen with ovarian cancer where other conditions’ symptoms tend to come and go.

The following are additional symptoms patients may experience with ovarian cancer:

• persistent indigestion, gas, or nausea;

• diarrhea or constipation;

• urinary frequency;

• loss of appetite;

• weight loss or weight gain;

• increased abdominal girth;

• painful intercourse;

• bleeding during intercourse;

• lack of energy;

• lower back pain;

• pain in the pelvic area; and

• abnormal vaginal bleeding.

Types of Ovarian Cancer
Types of ovarian cancer include the following:

• epithelial tumor in the epithelium;

• germ cells in the egg-producing cells; and

• stromal cells in estrogen and progesterone-producing tissue.

Diagnosis
The following are diagnostic tests that physicians may perform to help identify whether patients have ovarian cancer:

• pelvic examination to check for masses and growths;

• pelvic ultrasound to check for masses and growths;

• cancer antigen 125 blood test which may be an abnormally high level if ovarian cancer is present;

• computed tomography; and

• magnetic resonance imaging.

If ovarian cancer is suspected based on the results of the diagnostic studies, the physician may choose to perform an exploratory laparotomy with biopsy of an ovary (54.11 + 65.12) or laparoscopy with ovarian biopsy (65.13) to confirm the diagnosis.

Staging
The following stages are used for ovarian cancer:

• stage 1 — cancer is confined to one or both ovaries;

• stage 2 — cancer has spread to other locations in the pelvis such as the uterus or fallopian tubes;

• stage 3 — cancer has spread to the peritoneum or lymph nodes within the abdomen; and

• stage 4 — cancer has spread to organs beyond the abdomen.

Treatment
Treatment depends on the stage of the disease and usually involves a combination of surgery and chemotherapy. Frequently, the surgery involves the removal of both ovaries, the uterus, both fallopian tubes, nearby lymph nodes, and the omentum. The following are possible code assignments depending on the extent of procedure performed:

• Oophorectomy — removal of ovary. Unilateral oophorectomy is classified to code 65.39; that by laparoscope goes to code 65.31. Bilateral oophorectomy is classified to code 65.51; that by laparoscope goes to code 65.53.

• Salpingo-oophorectomy — removal of the fallopian tubes and ovaries. Unilateral salpingo-oophorectomy is classified to code 65.49; if done by laparoscope, use code 65.41. Bilateral salpingo-oophorectomy is classified to code 65.61; if done by laparoscope, use code 65.63.

• Hysterectomy, which is the removal of the uterus, is classified to codes 68.3-68.9. Specific code assignment depends on approach and extent.

• Removal of regional lymph nodes — 40.3

• Omentectomy — 54.4

Chemotherapy (99.25) may involve one or a combination of the following chemotherapeutic agents:

• carboplatin (Paraplatin);

• cisplatin; and

• paclitaxel (Taxol).

Coding and sequencing for ovarian cancer are dependent on 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, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 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. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

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