October is Breast Cancer Awareness Month, a time dedicated to increasing awareness and education about breast cancer. According to the National Cancer Institute (NIH), breast cancer is the second most common cancer in women after skin cancer.
Breast cancer affects one in eight women in the United States every year and 2.3 million women worldwide. The Centers for Disease Control and Prevention (CDC) states that in the U.S., approximately 30% of all newly diagnosed cancers in women are breast cancer.
For medical billing professionals, this month is a crucial reminder of the importance of accurate breast cancer diagnosis coding. Accurate coding ensures that healthcare providers are reimbursed correctly and that patients receive the appropriate care. It also supports clinical research and public health initiatives to improve breast cancer outcomes.
Conversely, missteps in coding can lead to denied claims, delayed payments, and compliance issues. Therefore, it is crucial to understand breast cancer diagnosis coding to ensure accuracy, expedite the billing process, and maintain compliance with regulatory standards.
Breast cancer diagnosis coding
In 2024, regarding genetic susceptibility, there are new ICD-10-CM code updates such as code Z15.02: Genetic susceptibility to malignant neoplasm of the breast and code Z15.03 Genetic susceptibility to malignant neoplasm of the breast (BRCA1 and BRCA2).
Also, there are expanded codes for specific types of breast cancer:
- C50.211: Malignant neoplasm of upper-inner quadrant of right female breast
- C50.212: Malignant neoplasm of upper-inner quadrant of left female breast
- C50.311: Malignant neoplasm of lower-inner quadrant of right female breast
- C50.312: Malignant neoplasm of lower-inner quadrant of left female breast
There are also CPT coding updates such as:
New and updated biopsy codes:
- 19085: Biopsy, breast, with placement of breast localization device(s) and imaging of biopsy specimen, percutaneous; first lesion, including stereotactic guidance
- 19086: Each additional lesion, including stereotactic guidance
Advanced imaging codes:
- 77049: MRI of breast, without and with contrast, bilateral
- 77048: MRI of breast, without and with contrast, unilateral
Tips for accurate breast cancer diagnosis coding
- Ensure detailed documentation: Encourage healthcare providers to document all relevant details about the breast cancer diagnosis, including the exact location, laterality, histological type, and stage of the cancer. After all, detailed documentation is essential for selecting the most accurate codes.
- Verify laterality: Always double-check that the breast cancer’s laterality (right, left, or bilateral) is correctly documented and coded. Errors in laterality can lead to claim denials.
- Stay updated with coding changes: Review updates to ICD-10 and CPT codes regularly. Coding guidelines and codes are periodically revised, and staying informed about these changes ensures compliance and accuracy.
- Use specific codes when available: Describe the patient’s condition and procedures using the most specific ICD-10 and CPT codes. Also, avoid using unspecified codes whenever possible.
- Understand treatment protocols: Familiarize yourself with standard breast cancer treatment protocols and the corresponding codes. This includes surgeries, chemotherapy, radiation therapy, and other treatments. Moreover, knowing these protocols can help you anticipate the appropriate codes and avoid errors.
- Conduct regular audits: Implement regular internal audits of breast cancer coding to identify and correct errors proactively. Above all, audits help maintain a high standard of coding accuracy and can identify areas for improvement in documentation and coding practices.
- Collaborate with clinicians: Foster open communication between coders and clinicians to ensure that all relevant clinical details are captured in the medical record. This collaboration can help resolve ambiguities and improve the accuracy of the codes assigned.
- Utilize coding resources: For guidance and support, consult coding manuals, online resources, and professional organizations like the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
- Attend continuing education: Participate in continuing education opportunities to stay current with coding best practices and updates. Workshops, webinars, and certification courses can enhance your coding skills and knowledge.
At Health Prime, we can help!
At Health Prime, we understand the complexities of breast cancer diagnostics and billing, and we’re here to help. Our team of experienced medical billing professionals handles every detail of coding and claims processing with precision and accuracy. We prioritize compliance and stay current with the latest coding guidelines to ensure smooth reimbursement for your practice.
Our comprehensive support services extend beyond just billing—we offer detailed documentation review, regular staff training, and personalized account management to streamline your billing operations.
Learn more about outsourcing your coding processes by reaching out to us at [email protected]. Our team will set up a meeting to discuss how Health Prime can maximize your revenue by cutting costs, saving you time, and collecting more!
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