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Coding / Medical Billing Today's Top Viewed: Thanks for the info. A friend had suggested them.. (Views: 39)

guideline - levette

Posted: Dec 21st, 2018 - 8:21 am In Reply to: Mets - former Andrews student/grad

First, let me say thank you Former Andrews student/grad for engaging me in this conversation.  I feel I must be wrong, due to the chronicity of the "rule," but I really want to understand the rationale!
The "rule" comes from CMS:
https://www.csscoperations.com/internet/Cssc.nsf/files/ra-particpantguide_120607.pdf/$FIle/ra-particpantguide_120607.pdf

First, let me say thank you Former Andrews student/grad for engaging me in this conversation.  I feel I must be wrong, due to the chronicity of the "rule," but I really want to understand the rationale!


The "rule" comes from CMS, pg 151, "Cancer coding requires detailed specificity"

https://www.csscoperations.com/Internet/Cssc3.Nsf/files/participant-guide-publish_052909.pdf/$File/participant-guide-publish_052909.pdf

I see organizations have incorporated this into the guidelines to coders.

I am taking a very well known Risk Adjustment training program and this question was on a practice exam:  "retroperitoneal carcinoma."  No other context given. How would you code it?

It was coded like the "bone cancer" example in this pdf; i.e. as a secondary malignant neoplasm.  I was then told about the CMS guidance and I was quite surprised!  He told me (us) that he himself hadn't heard of this "coding guideline" and searched for quite a while before realizing CMS meant The Coding Clinic, the 1985 one.

If you took that CCS prep course and still have the homework with answers, then you may find the question "Name five of the sites that are classified as secondary sites when there is a malignant neoplasm that is not otherwise specified. " (of course there are more than 5 sites). This question was from The Coding Handbook. Note once again there is no mention of there being metastatic disease.

It's unclear to me whether this "rule" applies only to CMS Risk Adjustment, but I saw it mentioned even in Inpatient Medical Coders Facebook group.  The Coding Handbook is usually cited as the source, which to me isn't official coding guidelines even though it is put out by AHA.

Since you are CRC certified, you might have some insight?





LINK/URL: RA Participant Guide

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