Here is a look at pancreatic cancer, diagnosis, treatment, and how to report it on your medical claims. Pancreatic cancer starts in the pancreas and pancreatic adenocarcinoma is the most common type. It starts when exocrine cells in the pancreas start to grow out of control. According to the American Cancer Society, pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths. As there is no single diagnostic test to determine pancreatic cancer, a series of imaging scans, blood tests, and biopsies is necessary. As this cancer type doesn’t cause symptoms until it has spread to other organs, it is seldom detected in its early stages. Pancreatic cancer treatment options may include surgery, chemotherapy, radiation therapy or a combination of these. Treatment will be chosen based on the extent of the cancer. Gastroenterology or surgical oncology practices providing treatment for pancreatic cancer have to use the right CPT codes to report diagnosis and treatments on the medical claims. Such busy practices can choose to partner with professional medical coding companies to get their claim submission done without any delay.
A recent AAPC blog highlights the CPT codes that can be used to report pancreatic cancer diagnostic tests and most recommended surgeries.
Let us check them out.
Diagnostic tests recommended to detect pancreatic cancer include imaging tests (Ultrasonography, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI), Positron emission tomography (PET) scan and Endoscopic ultrasound (EUS)), Blood tests and Biopsy.
Imaging Tests
Imaging tests help to create pictures of the inside of the body so that doctors can visualize structures such as the pancreas. Codes used to report these tests are –
Ultrasonography
76700 Ultrasound, abdominal, real time with image documentation; complete
76705 Ultrasound, abdominal, real time with image documentation; limited (e.g. single organ, quadrant, follow-up)
Computerized tomography (CT) scans
- 74150 Computed tomography, abdomen; without contrast material
- 74160 Computed tomography, abdomen; with contrast material(s)
- 74176 Computed tomography, abdomen and pelvis; without contrast material
- 74177 Computed tomography, abdomen and pelvis; with contrast material(s)
Magnetic resonance imaging (MRI) scans
- 74181 Magnetic resonance (e.g. proton) imaging, abdomen; without contrast material(s)
- 74182 Magnetic resonance (e.g. proton) imaging, abdomen; with contrast material(s)
- 74183 Magnetic resonance (e.g. proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences
Positron emission tomography (PET) scan
- 78813 Positron emission tomography (PET) imaging; whole body.
Endoscopic ultrasound (EUS) – Here, you have to select the code based on what part of the gastrointestinal tract is being scoped.
If the esophagus is examined via EUS, use the code
- 43231 Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination
Biopsy
Biopsies can be done in different ways – Percutaneous (through the skin), Endoscopic or Surgical biopsy.
Codes used include
- 48100 Biopsy of pancreas, open (e.g. fine needle aspiration, needle core biopsy, wedge biopsy) and 48102 Biopsy of pancreas, percutaneous needle
Blood Tests
These tests help to detect specific proteins (tumor markers) shed by pancreatic cancer cells. Main tumor marker test used in pancreatic cancer is CA19-9. However, CA19-9 cannot be used to screen patients, but is helpful in monitoring how the cancer responds to therapy.
CA19-9 can be reported using code –
- 86301 Immunoassay for tumor antigen, quantitative; CA 19-9
Certain payers such as the Centers for Medicare & Medicaid Services (CMS) do not cover this test for the evaluation of patients with signs or symptoms suggestive of malignancy.
Surgical Treatment Codes
The next step is to document the treatment performed such as surgery, chemotherapy, radiation therapy, or a combination of these treatment types.
Codes used to report surgeries for tumor excision in people with pancreatic cancer include:
Distal Pancreatectomy – During this surgery, the left side of the pancreas is removed. The spleen may also need to be removed.
- 48145 Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomy
- 48146 Pancreatectomy, distal, near-total with preservation of duodenum (Child-type procedure)
Total Pancreatectomy – This surgery is done to remove the entire pancreas, as well as the gallbladder, spleen, and part of the stomach and small intestine.
- 48155 Pancreatectomy, total
Whipple procedure (pancreaticoduodenectomy, pancreatoduodenectomy) – During this procedure, tumors in the head of the pancreas is removed. Whipple procedures also include – removal of the head of the pancreas (partial pancreatectomy; subtotal), removal of at least a portion of the duodenum (duodenectomy) and joining of the common bile duct to the intestine (choledochoenterostomy).
Codes used to report a Whipple procedure are
- 48150 Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with pancreatojejunostomy
- 48152 —————-; without pancreatojejunostomy
- 48153 Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomy
- 48154 —————-; without pancreatojejunostomy
Make sure that your coding team is familiar with these codes and they are up to date with the changing coding and billing standards. Consider medical coding outsourcing for error-free claim submission and thus better revenue cycle management.
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