Metastatic cancer: How to use primary and secondary ICD-9s

Why This Topic Matters

Accurate ICD-9 diagnosis selection and sequencing can affect claim acceptance, medical necessity review, and whether metastatic disease is represented correctly in the record.

Article Sections

1. Distinguishing primary and secondary malignancy coding

   This section discusses how metastatic cancer is identified in the record and why source wording from the physician matters. It also covers general issues that arise when determining whether a malignancy is primary or secondary.

2. Sequencing diagnoses for metastatic treatment and Zometa billing

   This section focuses on claim sequencing in metastatic cancer scenarios, including treatment situations involving bone metastases and related billing considerations. It also addresses how diagnosis order can affect reimbursement for services and drugs.

3. Double meanings for primary and secondary

   This section explains the difference between clinical terminology and claim-position terminology when discussing primary and secondary diagnoses. It addresses situations where the site being treated may not match the original source of the cancer.

4. When to use history of ICD-9s

   This section covers circumstances in which a prior malignancy is no longer active and a personal history code may be appropriate. It also references general coding guidance from the ICD-9-CM manual and the American Hospital Association.