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October 30, 2006
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 • 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 • epithelial tumor in the epithelium; • germ cells in the egg-producing cells; and • stromal cells in estrogen and progesterone-producing tissue. Diagnosis • 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 • 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 • 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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