Q&A Malignant ascites primary site unkown

[marcyreif]

How do you code malignant ascites primary site unknown. I have coded it as 197.1 for malignant ascites and 199.1 for the primary site unknown. My counter part wants to code it 789.59 and 199.1?

 

[Luna]

If I may ask: What is your thought process for using code 197.1 for the malignant ascites? (I'm a student and was curious about your reasoning. Right or Wrong, I like to understand what thoughts a person has to support a code they've chosen.)

 

[marcyreif]

If I may ask: What is your thought process for using code 197.1 for the malignant ascites? (I'm a student and was curious about your reasoning. Right or Wrong, I like to understand what thoughts a person has to support a code they've chosen.)

My thought process is that they are stating that the primary cancer site is unknown and I presume that the malignant acites is secondary neoplasm and if you look up malignant ascites it states cancer of the pertioneal fluid. And it seems to come up on all students homework when they are learning to code.

 

[Luna]

Is this a test question with multiple answers you are debating? Like I said, I'm a student, so I'm just musing here to exercise my own reasoning skills. The "real" coders will jump in soon to correct any faulty reasoning I present.

I'm wondering if there might be a slight misunderstanding about what "malignant ascites" is. It is not uncommon for it to be assumed the same as or synonymous to peritoneal carcinomas. "Malignant ascites" is not a cancer. Instead it is a condition solely caused by cancer. Thus it is called "malignant ascites" or "malignancy-related ascites". Maybe the term "malignant" is causing the confusion that it is a neoplasm/cancer of the peritoneal cavity, when instead, "malignant ascites" means that a cancer is causing the ascites condition.

So, to me code 789.51 malignant ascites makes sense. I'm trying to understand why your counter part chooses 789.59 Other ascites, unless that is the only other option on the quiz. (Assuming it's a quiz question we're discussing. In which case, I'm not sure what the other options are, if there is one better than 789.59 or not.)

Also, code 199.1 I think is appropriate in this case since we know the patient must have cancer causing the ascites, but the site is unknown.

 

[marcyreif]

I had this question come up in my coding courses when I was going to school. And according to AHIMA books it would be 197.6 and 199.1 because if you read under 789.59 it states if is a malignant ascites is cancer of peritoneum. That's the only way I can explain it.

 

[Luna]

789.59 is for "other ascites" and is not used for "malignant ascites" and is not a cancer.

789.51 is for "malignant ascites" and the note is to "code first the malignancy, such as malignant neoplasm of....." providing two examples of cancers (183.0; 197.6) that could be responsible for the "malignant ascites." It is not stating that "malignant ascites" is cancer of peritoneum. It is just saying that when using code 789.51 you will also need to provide an appropriate neoplasm code. Which in the case you present would be 199.1 primary neoplasm unknown.

So, if your AHIMA book is truly stating that "malignant ascites" should be coded as 197.6 and 199.1 I would really be confused. If that is correct, I need someone who can provide the resources explaining that to me.

For now, I'm leaning toward 789.51 Malignant ascites, and 199.1 neoplasm unknown.

 

[marcyreif]

Previously I asked and we have come to the conclusion that it would 197.6 (because it is cancer), 199.1( primary site unkown), and third 789.51. It basically doesn't give you enough information. Do we know that the malignant ascites a cancer or not. We as coders would need to query the physician.

 

[Luna]

Malignant ascites is not cancer. It is the result of cancer. It is termed "malignant" only because it is a malignancy that is causing the ascites condition and not something like cirrhosis or tuberculosis or something other than a cancer. It is like 789.51 is a manifestation code, and therefore needs to be coded with the appropriate neoplasm code first. Which, in this case is 199.1 because the primary cancer is not known.

Please check out these resources.
http://www.medicinenet.com/ascites/article.htm#what_is_ascites (Pay particular attention to the 5th paragraph under the subheading "Causes of Ascites"

http://www.uptodate.com/contents/malignancy-related-ascites (Pay particular attention to the 1st paragraph under the heading "Etiology and Pathogenesis.")

 

[blondie8]

marcyreif, one thing we have to be very careful about is allowing our research to supercede what the ICD-9 book points us towards for coding. Because there is a specific entry in the index for ascites, malignant, then we have to use that code, not immediately assume that it's caused by metastatic cancer of the peritoneum. I code inpatient records and have noticed that malignant ascites can be caused by many different cancers. While 197.6 and 183.0 are two of the more common causes, I've also seen it caused by kidney, liver, pancreas, and colon cancers, to name a few.

But the big thing to remember is this: Since most patients don't enter the acute care setting for treatment of ascites alone, (easy to do a quick paracentesis in the IRL suite,) there will almost always be a more acute and severe condition that is going to have to take the principal diagnosis slot. If the doctor gives us "malignant ascites," without immediately documenting a cause, then it's our clue to do some sleuthing in the record and track it down. And of course, you're absolutely right - if the doctors never specify, then it's time to write yet another query. (One of the hospitals that is a client of my company's is in the middle of a big CDI project, and I swear I write 10 queries per day!! )

 

[Carolyn Heath]

Here is a link that may explain about malignant ascites better: http://www.icd9data.com/2013/Volume1/780-799/780-789/789/789.51.htm.

 

[Luna]

marcyreif, one thing we have to be very careful about is allowing our research to supercede what the ICD-9 book points us towards for coding. Because there is a specific entry in the index for ascites, malignant, then we have to use that code, not immediately assume that it's caused by metastatic cancer of the peritoneum. I code inpatient records and have noticed that malignant ascites can be caused by many different cancers. While 197.6 and 183.0 are two of the more common causes, I've also seen it caused by kidney, liver, pancreas, and colon cancers, to name a few.

But the big thing to remember is this: Since most patients don't enter the acute care setting for treatment of ascites alone, (easy to do a quick paracentesis in the IRL suite,) there will almost always be a more acute and severe condition that is going to have to take the principal diagnosis slot. If the doctor gives us "malignant ascites," without immediately documenting a cause, then it's our clue to do some sleuthing in the record and track it down. And of course, you're absolutely right - if the doctors never specify, then it's time to write yet another query. (One of the hospitals that is a client of my company's is in the middle of a big CDI project, and I swear I write 10 queries per day!! )

OK, so I think I understand it correctly and in the given scenario then, 197.6 would be inappropriate. And the correct coding would be just the 199.1 and 789.51???

 

[blondie8]

Yes, Luna, I think that's exactly right! I haven't been coding for super long, but I got 100%'s on both my RHIT and CCS exam, and my boss has had me auditing other coders' work for DRG's for 7 months now, so I'm getting pretty comfortable with some of this stuff. Other things, like complex peripheral arterial surgeries have me tearing my hair out sometimes!!!

 

[Ruth Sheets]

Alicia Scott spoke about this topic in the August 2013 Q&A Webinar. Join the CCO Club to see the replay video and to gain access to the answer sheets.

 

[Carolyn Heath]

Thank you, Ruth! Looking forward to download the August 2013 answer sheet.