Author: Keisha Wilson CCS, CPC, CRC, CPB, CPMA, AAPC Approved Instructor
Lung Cancer Awareness Month
November is Lung cancer awareness month. Lung cancer is the most common cause of cancer mortality in the United States and worldwide. Smoking is the most common cause of lung cancer. Other risk factors for lung cancer include but are not limited to being exposed to secondhand smoke, having a family history of lung cancer, asbestos, ext. When smoking is combined with other risk factors and commodities, the risk of lung cancer is increased significantly.
Importance of Provider Documentation
Documentation is key when documenting and diagnosing patients with lung cancer. It is imperative for providers’ documentation to be clear and note signs and symptoms, rule out versus definitive diagnosis. This is vital in documenting inpatient encounters where rule-out can be coded as opposed to the outpatient setting where if a definitive diagnosis is not reached only signs and symptoms should be coded. Patients with lung cancer may also have other chronic conditions as well such as Asthma, COPD, and Emphysema that may be exacerbated. If a patient has other chronic conditions the risk factors are higher and a provider will need to take each one of them into account as well as the medication the patient is taking.
While conducting audits and chart reviews some additional documentation, I look for is; is the cancer current versus history, primary versus secondary (C34, C78 vs Z85 code). Is the patient still receiving active treatment? Or on therapies? Per ICD 10 guidelines if the patient is no longer receiving active treatment, then Z85 “Personal History of Malignant Neoplasm” should be documented. “Any mention of extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The secondary site may be the principal or first-listed diagnosis with the Z85 code used as a secondary code”.
Is documentation clear if the patient is a current smoker versus has a smoking history? Has the patient quit? When did they quit? Are they in remission? Why are these questions important you ask? That is because each response would require the reporting of different diagnosis codes. Code F17, for nicotine dependence and type of nicotine dependence the patient has or Z87, and history of smoking. If the patient is a current smoker is a frequency of how many packs noted? Per day, month, or year? If a provider conducts lung cancer screening, documentation must include how many packs the patient smokes and if counselling and education were provided.
All of the above plays a crucial role in documentation to allow the accurate reporting of diagnosis codes to the highest level of specificity, as well as allow for additional diagnosis codes that explain the patient other condition being treated/managed.
Lung Cancer Screening
When screening patients as early prevention providers in recent years have turned to the order of Low-dose computed tomography (LDCT). The goal of this test is to screen patients who are asymptomatic but deemed high risk for lung cancer. The screening is to detect the disease in its early stage, before the patient becomes symptomatic and when treatment deems to have the most successful results. The Centers for Disease Control and Prevention (CDC) recommends yearly cancer screening with LDCT for people who:
- Have a 20-pack-year or more smoking history, and
- Smoke now or have quit within the past 15 years, and
- Are between 50 and 80 years old.
The Task Force recommends that yearly lung cancer screening stop when the person being screened:
- Turns 81 years old, or
- Has not smoked in 15 or more years, or
- Develops a health problem that makes him or her unwilling or unable to have surgery if lung cancer is found.
Some lung cancers grow slowly and others grow and spread at a fast pace. If a patient is a smoker, has a history of smoking, have been exposed to secondhand smoking or other hazardous smoke or dust it is recommended that they speak with their healthcare provider and come up with a plan of care.
If you have any questions regarding the documentation and coding of Lung Cancer and other chronic conditions or would like us to conduct a chart review, or conduct provider education contact us at keisha@kwadvancedconsulting.com.
Resources:
https://www.cms.gov/files/document/fy-2023-icd-10-cm-coding-guidelines.pdf
