HCC Prompts/Suspecting Logic
This condition, characterized by an abnormal buildup of cerebrospinal fluid in the brain, often requires placement of a VP shunt.
Hydrocephalus
Please provide the condition diagnosis for this patient: 72M with multiple myeloma completed treatment 3 years ago. Oncology records state that the patient has no evidence of active disease.
Multiple Myeloma in remission (C90.01)
A diagnosis of DM2 can be made: With classic symptoms of hyperglycemia (_____, _____) and a random blood glucose ___ mg/dL.
thirst, polyuria, weight loss, blurry vision (Name at least 2), and random blood glucose of ≥200?
Daily Double!
What are the three main types of heme malignancies? Leukemia, Lymphoma, and multiple myeloma
True,
Lymphoma is found in lymph nodes, thymus, spleen…; distant sites are not mets
Multiple myeloma is seen in bones (lytic lesions); these are not mets
What stretchy suspect can you create when a patient has atrophy of the pancreas?
Chronic pancreatitis (K86.1) Per NIH Article 'Atrophic-appearing Pancreas on Magnetic Resonance Cholangiopancreatography as Initial Presentation of Cystic Fibrosis' Introduction: "Pancreatic atrophy is typically seen in elderly patients or those patients who have sequelae of chronic pancreatitis."
Please provide the diagnosis condition for this patient: 68M with acute myeloid leukemia diagnosed 3 years ago. He has completed treatment since then. Oncology records state that the patient has no evidence of active disease.
AML (acute myeloid leukemia) in remission (C92.01)
A diagnosis of DM2 can be made:
When a patient is asymptomatic but has two consecutive HbA1c ≥ ___ and /or a fasting glucose value ≥ _____
6.5%, 126 mg/dL
If the neoplasm becomes metastatic, it has spread beyond the primary affected organ. What two codes are needed?
One for the primary site
One for the metastatic, or secondary, site = “secondary malignant neoplasm”
True or False: Malignant effusion=cancer
True-
Fluid collection containing cancer cells
Usually around the lungs (pleural space), heart (pericardial space) or in the abdominal cavity (ascites)
Check for and document the presence of percutaneous drain (“pigatil”)
We need to create a suspect for alpha-1 antitrypsin deficiency when we see the following 4 conditions documented:
Emphysema, Chronic bronchitis, Bronchiectasis, Cirrhosis
*** We don't if they have COPD documented because autologic will catch this
Per September Diagnosis Excellence and Clinical Guideline Education Series: National and OSH COPD guidelines state all patients with COPD, emphysema, chronic bronchitis, bronchiectasis and Cirrhosis should be tested for AAT deficiency (with serum AAT level - CPT code 82103)
72M presents with cough, weight loss. Chest xray shows R lower lobe mass. Brain CT shows L frontal lobe enhancing lesion. Bronchoscopy is performed, biopsy shows adenocarcinoma of right lung. He later undergoes R lower lobectomy, removing the tumor in its entirety.
The patient is diagnosed with
Secondary malignant neoplasm brain C79.31
History of malignant neoplasm lung Z85.118
True or False: Type 2 diabetes mellitus without complication (E11.9) risk adjusts less than Type 2 diabetes mellitus with diabetic polyneuropathy (E11.42).
False: Type 2 diabetes mellitus with or without complications now risk adjust the SAME in V28. HCC 38 and HCC 37 risk adjust the same.
Name a benign carcinoid tumor that risk adjusts in the HCC model 28
Carcinoid tumor: A type of neuroendocrine tumor that can produce hormones
Sarcoma, carcinoma, malignant or secondary carcinoid, carcinoid syndrome
True or False: You can suspect chronic pancreatitis in a patient if their pancreas has cysts or calcifications
True, Cystic lesions of pancreas can be inflammatory fluid collections, non-neoplastic, or neoplastic1. Inflammatory fluid collections are signs pancreatitis
This diagnosis often appears on echocardiogram reports when right ventricular systolic pressure (RVSP) is elevated above ___.
Pulmonary hypertension, >30
73 YO M with squamous cell lung carcinoma (T3N2 vs stage IV due to suspicious gastro-hepatic node, liver), PD-L 1 70% on Pembrolizumab presents from clinic for several months of fatigue and weight loss.
Which two malignancy codes should this patient be coded with?
Malignant neoplasm of upper lobe, right bronchus or lung (C34.11)
+
Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes (C77.2)
If HCC 38 is suspected or documented, only suspect for HCC 37 if ______, ________, or _______ complications are involved.
kidney, eye or skin complications. **If CKD3 and HCC 38 are already documented, do not suspect for HCC 37
True or False: A patient should be coded with Breast cancer if they are s/p mastectomy and on tamoxifen
True-If you're treating a condition, it exists-
considered active, because the tamoxifen is still considered treatment
You can code active MI 30 days after a patient has had a myocardial infarction
False, guidelines state 28 days
A patient prescribed apixaban (Eliquis) or rivaroxaban (Xarelto) without a clear reason may prompt suspicion for this cardiac rhythm disorder.
Atrial fibrillation
72M presents with cough, weight loss. Chest xray shows R lower lobe mass. Brain CT shows L frontal lobe enhancing lesion. Bronchoscopy is performed, biopsy shows adenocarcinoma of right lung.
The patient is diagnosed with what two conditions?
Malignant neoplasm of lower lobe, right bronchus or lung C34.31
Secondary malignant neoplasm of brain C79.31
What are two ophthalmologic complications of diabetes that we need to add codes for and what HCC do they fall in?
Proliferative Retinopathy, NPDR with macular edema, macular edema (+added code HCC 298) (will also accept central retinal vein occlusion, vitreous hemorrhage)
True or False: A patient has history of malignant neoplasm if they had prostate cancer s/p radiation and are receiving leuprolide, or Lupron.
False, this is considered active prostate cancer, because Lupron/leuprolide is treatment.
If the patient with cirrhosis stops drinking alcohol and their liver tests normalize, the cirrhosis can be considered cured.
False, while the liver can regenerate some healthy tissue after damage and fully reverse conditions such as mild fatty liver, the scar tissue that is seen with cirrhosis remains-the damage is permanent, though progression can stop.