HCC Coding Corner | Oncology and Hematology

HCC categories that are relevant to the Oncology and Hematology specialty:
• HCC 8: Metastatic Cancer and Acute Leukemia
• HCC 9: Lung and Other Severe Cancers
• HCC 10: Lymphoma and Other Cancers
• HCC 11: Colorectal, Bladder, and Other Cancer
• HCC 12: Breast, Prostate, and Other Cancers and Tumors
• HCC 46: Severe Hematological Disorders
• HCC 47: Disorders of Immunity
• HCC 48: Coagulation Defects and Other Specified Hematological Disorders

What Providers Should Do:

• Code for all conditions that affect or influence patient care, treatment or management.
• Code to the highest specificity including any complications

ICD-10 Coding scenarios associated with these conditions:

Example 1: A 72 year old male presents for a follow up visit for Hodgkin’s Lymphoma. The patient has
a prior stem cell transplant and agranulocytosis due to chemotherapy.
ICD-10 Code Description- Partial Coding HCC Weight
C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, neck 0.675
Not coded Stem cell transplant status 0.000
Not coded Agranulocytosis secondary to cancer chemotherapy 0.000
Demographic Risk Factor (Community, Non Dual, Aged): 0.394
Total Score: 1.069
PMPM Payment: $855.20
Medicare expects this patient to cost: $10,262.40
ICD-10 Code Description- Coding Highest Specificity HCC Weight
C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, neck 0.675
Z94.84 Stem cell transplant status 0.832
D70.1 Agranulocytosis secondary to cancer chemotherapy 0.665
N/A Interaction between immune disorders and cancer 0.838
Demographic Risk Factor (Community, Non Dual, Aged): 0.308
Total Score: 3.404
PMPM Payment: $2,723.20
Medicare expects this patient to cost: $32,678.40

Example 2: A 68 year old female presents for a follow up visit. The patient has colorectal cancer with
ongoing treatment, a permanent colostomy and a known diagnosis of Von Willebrand's disease.
ICD-10 Code Description- Partial Coding HCC Weight
C19 Malignant neoplasm of rectosigmoid junction 0.307
Not coded Colostomy status 0.000
Not coded Von Willebrand's disease 0.000
Demographic Risk Factor (Community, Non Dual, Aged): 0.323
Total Score: 0.630
PMPM Payment: $504.00
Medicare expects this patient to cost: $6,048.00

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 ICD-10 Code Description- Coding Highest Specificity HCC Weight
C19 Malignant neoplasm of rectosigmoid junction 0.307
Z93.3 Colostomy status 0.534
D68.0 Von Willebrand's disease 0.192
Demographic Risk Factor (Community, Non Dual, Aged): 0.323
Total Score: 1.356
PMPM Payment: $1,084.80
Medicare expects this patient to cost: $13,017.60

Example 3: A 65 year old male presents for prostate cancer with metastasis to the bone.
ICD-10 Code Description- Partial Coding HCC Weight
C61 Malignant neoplasm of prostate 0.150
Not coded Secondary malignant neoplasm of bone 0.00
Demographic Risk Factor (Community, Non Dual, Aged): 0.308
Total Score: 0.458
PMPM Payment: $366.40
Medicare expects this patient to cost: $4,396.80
ICD-10 Code Description- Coding Highest Specificity HCC Weight
C61 Malignant neoplasm of prostate Inclusive
C79.51 Secondary malignant neoplasm of bone 2.659
Demographic Risk Factor (Community, Non Dual, Aged): 0.308
Total Score: 2.967
PMPM Payment: $2,373.60
Medicare expects this patient to cost: $28,483.20

Example 4: A 78 year old female presents with renal cancer. The patient has end stage renal disease with
dependence on renal dialysis.
ICD-10 Code Description- Partial Coding HCC Weight
C64.1 Malignant neoplasm of right kidney 0.307
Not coded End stage renal disease with dependence on renal dialysis 0.000
Demographic Risk Factor (Community, Non Dual, Aged): 0.451
Total Score: 0.758
PMPM Payment: $606.40
Medicare expects this patient to cost: $7,276.80
ICD-10 Code Description- Coding Highest Specificity HCC Weight
C64.1 Malignant neoplasm of right kidney 0.307
N18.6, Z99.2 End stage renal disease with dependence on renal dialysis 0.435
Demographic Risk Factor (Community, Non Dual, Aged): 0.451
Total Score: 1.193
PMPM Payment: $954.40
Medicare expects this patient to cost: $11,452.80

Coding Tip: History of Cancer vs. Active Cancers

• When a primary malignancy has been previously excised or eradicated from its site, there is no
further treatment directed to that site, and there is no evidence of any existing primary
malignancy, a code from category Z85, Personal history of malignant neoplasm, should be used
to indicate the former site of the malignancy.
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-CM-Coding-Guidelines.pdf

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