Tumor Tip of the Week- 06-21-2024 Make sure you are recording all treatment -includes treatment done-recommended-refused-contraindicated - Omega Healthcare

Tumor Tip of the Week- 06-21-2024 Make sure you are recording all treatment -includes treatment done-recommended-refused-contraindicated

Tumor Tip header image

Just as important as it is to code the treatment a patient received, you also need to code when a treatment is not given due to various reasons, like contraindicated, patient expired, patient refused, or recommended but unknown if done- be sure to follow up on those cases. It is important to document why standard of care was not given.  Below are examples of various scenarios.

Scenario Question Answer Rationale & Discussion
pT2 pN0 cM0 Stage 1 Thyroid Ca

 

Med Onc-Given size of the tumor of 3.7 cm and proximity to edge of thyroid gland we discussed that she may benefit from RAI [radioactive iodine] We will plan to do remnant ablation with RAI

 

At time of abstracting, no further info available.

 

How would you code Reason for No Radiation? 8 Radiation therapy was recommended, but it is unknown whether it was administered STORE/SEER Program Coding & Staging Manual – Code 8 If it is known that a physician recommended radiation treatment, but no further documentation is available to confirm it was given.

 

Note: Cases coded 8 should be followed and updated to a more definitive code as appropriate.

 

cT1 cN0 cM0 Stage 1 Endometrial cancer-recommended to have TAH/BSO but expired prior to surgery being given. How would you code Reason for No Surgery of Primary Site? 5 Surgery of the primary site was not performed because the patient died prior to planned or recommended surgery. STORE/SEER Program Coding & Staging Manual –

Code 5 If Surgery of the primary site was not performed because the patient died prior to planned or recommended surgery.

cT3 cN0 cM0 Colon Cancer

 

Med Onc- Patient doesn’t want any form of chemotherapy, daughters all agree.

 

How would you code Chemotherapy? 87

Chemotherapy was not administered. It was recommended by the patient’s physician, but this treatment was refused by the patient, a patient’s family member, or the patient’s guardian. The refusal was noted in patient record.

STORE/SEER Program Coding & Staging Manual

Assign code 87 when

  • The patient refused recommended chemotherapy
  • The patient made a blanket refusal of all recommended treatment and chemotherapy is a customary option for the primary site/histology
  • The patient refused all treatment before any was recommended and chemotherapy is a customary option for the primary site/histology

 

 

 

Patient dx with cancer NCCN guidelines for this site/ histology/ stage of cancer are Surgery/ followed by Chemo+ Radiation+ Immunotherapy. Patient refused all further workup and treatment before any recommendations could be made. How would you Code

Reason No Srg

Reason No Xrt

Chemo

Immunotherapy

Rsn No Srg-7 Refused

Rsn No Xrt 7 Refused

Chemo 87 Refused

Immunotherapy 87 Refused

STORE/SEER Program Coding & Staging Manual

Assign code 87 when

  • The patient refused all treatment before any was recommended and that treatment is a customary option for the primary site/histology
cT1a cN1 cM0 Lung Cancer

 

Med Onc- need adjuvant therapy Carboplatin/ pemetrexed followed by immunotherapy w/ pembrolizumab or atezolizumab

 

At time of abstracting, no further info available.

 

How would you code Chemotherapy?

 

How would you code Immunotherapy?

88 Chemotherapy was recommended, but it is unknown if it was administered

 

88 Immunotherapy was recommended, but it is unknown if it was administered

 

STORE/SEER Program Coding & Staging Manual

Assign code 88 when

  • Chemotherapy was recommended, but it is unknown if it was administered.

 

  • The only information available is that the patient was referred to an oncologist

Note: Review cases coded 88 periodically for later confirmation of chemotherapy /immunotherapy therapy.

Multiple Myeloma

Med Onc. Treated with daratumumab CyBorD … Patient has responded well to treatment. She will be referred for evaluation of autologous bone marrow transplant with the bone marrow transplant team.

 

Transplant Team- Overall poor KPS and Frailty assessment consistent with FRAIL state and overall high medium risk for high-risk interventions. In addition to other comorbid conditions including GI and pulmonary and age would disqualify her from Bone Marrow Transplant.

 

How would you code Hematologic Transplant and Endocrine Procedures? 82

Hematologic transplant and/or endocrine surgery/radiation was not recommended/administered because it was contraindicated due to patient risk factors (i.e., comorbid conditions, advanced age, progression of disease prior to administration, etc.).

STORE/SEER Program Coding & Staging Manual

Code 82 If Transplant procedure and/or endocrine therapy was not recommended/administered because it

was contradicted due to patient risk factors (i.e., comorbid conditions, advanced age, progression

of tumor prior to planned administration, etc.)

 

*Refer to Software Vendor for Instructions on the proper way to code 82-88, so the export is correct.

Comments are closed.