Q&A Confused about 197.6

[Carolyn Heath]

Thank you, Alicia!

 

[Luna]

Aw, I found this post. Sorry it took me so long. Ruth pointed me in the right direction. THANKS Ruth.
So, I think I may be part of the confusion here everyone. When we get a question on the Q&A and are not sure what the direction of the question is we sort of go with what we know. I think that is what happened and I may have made an assumption.

This is how I took the question.
A patient comes in with 789.59 which is those Ascites that I pronounce funny.
The patient is dx with 197.6 that caused the ascites. However this was an assumption of mine. It just so happens that it is also the code given as an example in the manual. What we do know is that if a person is coded 789.59 we need to first code the CA that caused the 789.59 per the guideline.
In the question I thought that it was stated the primary CA was mentioned but not given. When this happens in documentation that means you can use 199.1. If however the primary CA is not mentioned the code 197.6 is enough. It is a code for a secondary CA. That is sufficient for the Payer in most cases.

So this really boils down in my eyes to where the question came from. If this was a test question I would say that you would use the 199.1. They would be testing to see if you knew it and that the 789.59 was sequenced after the CA code.

If this is a real world case question that changes it a bit. You could leave off the 199.1 because it would depend on what the payer wanted.

I think I didn't get the gist of what the real question was. I may have read into it a bit. Let me know if I am on track here or if there is more to the question then I am seeing. I LOVE these type of questions with ICD-9.

Sorry for the confusion. Again, I am sure this was on my part.

Alicia, thank you very much for coming back to this. (Translated: Thank you very much for being patient with the very difficult soil of my brain.)

So, according to the Webinar the coding should be: 197.6; 199.1; 789.51

· secondary cancer of the retroperitoneum/peritoneum
· primary cancer; site unknown
· malignant ascites

Alicia, what you're saying then is that the stuff I crossed outabove were only part of the code sequence because of an assumption you made. Otherwise the code sequence would be 199.1 and 789.51? Or, actually I see you have 789.59 other ascites. Is it that or 789.51 malignant ascites?

And to make sure I understand your other comments here: had the secondary CA, 197.6, actually been supported in the documentation, then the sequence would be 197.6, 789.51 or 197.6, 199.1, 789.51 depending on whether the payer requires a primary CA code when the secondary is provided?


(I bet it gets very hard to keep all the different coding questions straight when you have so many to address at one time. You do a fantastic job though. I love how I can always "hear" a smile on your face during the webinars and even in your replies in the forums. It makes me confident I have an instructor who loves what she does, and loves sharing it with others.)

 

[Alicia Scott]

And to make sure I understand your other comments here: had the secondary CA, 197.6, actually been supported in the documentation, then the sequence would be 197.6, 789.51 or 197.6, 199.1, 789.51 depending on whether the payer requires a primary CA code when the secondary is provided? I agree. It all depends on the documentation and what the payer requires. Of course you would have the secondary insurance in your documentation. I did assume it was the one from something I read in the question. The key is to make sure you follow the guidelines given in the manual and you will be fine. I do love the webinars and the students. I think because I learn so much from all of the questions that come in.