Reporting Pancreatic Cancer – Use the Correct ICD-10 Codes

Reporting Pancreatic Cancer – Use the Correct ICD-10 Codes

Pancreatic cancer is caused by cells in the pancreas growing abnormally to form a tumor. The right ICD-10 codes must be used on medical claims.

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Pancreatic cancer begins in the tissues of the pancreas – a gland located deep in the abdomen, between the stomach and the spine – that releases enzymes that help in digestion and hormones that manage blood sugar levels. Pancreatic cancer occurs when abnormal cells in the pancreas grow and divide out of control and form a tumor. Tumors that develop interfere with the functioning of the pancreas. Pancreatic cancer is deadly as the tumors grow and spread rapidly to nearby organs. Tumors can develop either in the endocrine or the exocrine glands in the pancreas. The condition is rarely detected in its early stages. However, a few symptoms may occur when the condition reaches advanced stages and these include - abdominal pain, weight loss, diarrhea, and jaundice. Treatment modalities for the condition include surgery, chemotherapy, and radiation. Surgical oncologists and radiologists treating this condition can partner with a reputable radiology medical billing company that has expert billing and coding specialists on board to report and bill for this condition correctly.

According to the American Cancer Society, around 3 percent of all cancers in the United States are pancreatic cancers (2018 statistics). It is estimated that in 2018, about 55,440 Americans will be diagnosed with pancreatic cancer in the US and over 44,330 will die from the same.

A series of factors such as smoking, long-standing diabetes, chronic

inflammation of the pancreas (pancreatitis), obesity and poor diet can increase the risk of developing the disease. Pancreatic cancer develops when the cells in your pancreas develop mutation in your DNA. These mutations cause the cells to grow uncontrollably and to continue existing even after normal cells die forming a tumor. If left untreated, pancreatic cancer spreads to nearby organs and blood vessels and cause serious complications.

Types of Pancreatic Cancer Pancreatic tumors are either exocrine or endocrine (neuroendocrine). This is based on the type of cell they start in. Knowing the specific type of tumor is important as each type acts differently and responds to different treatments. 

Exocrine pancreatic cancer – Regarded as the most common type, these tumors normally affect the exocrine functions and can be malignant or benign. The most common type of pancreatic cancer is adenocarcinoma.

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Endocrine pancreatic cancer – Also called islet-cell tumors, these tumors affect the endocrine functions of the pancreas. These types of cancers are fairly uncommon and often grow slower than exocrine tumors.

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Signs and Symptoms of Pancreatic Cancer Often called a silent disease, pancreatic cancer symptoms do not show up in its early stages. In most cases, the signs and symptoms occur only when the disease has reached its advanced stages. Common symptoms include – 

Pain in the upper abdomen that radiates to your back

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New-onset diabetes

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Loss of appetite or unintended weight loss

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Fatigue

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Depression

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Blood clots

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Yellowing of your skin and the whites of your eyes (jaundice)

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Weakness or dizziness

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Chills and muscle spasms

However, if the cancer spreads to a new area, or metastasizes, new symptoms can occur in the affected area and the rest of the body.

How to Diagnose and Treat Pancreatic Cancer?

Experiencing one or more of the above mentioned symptoms does not mean that you suffer from pancreatic cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Diagnosis of this condition may begin with a detailed physical examination.

A wide range of diagnostic imaging tests such as - Ultrasound, Computerized tomography (CT) scans, Magnetic resonance imaging (MRI) and Positron emission tomography (PET) scans will be conducted as part of the diagnosis. An endoscopic ultrasound (EUS) will be performed to make images of the pancreas from inside the patient’s abdomen. In addition, biopsy (removing a tissue sample for testing) and blood tests (to check for specific proteins (tumor markers) shed by pancreatic cancer cells) will be performed as part of the diagnosis.

If the diagnosis tests confirm the presence of cancerous tumors, the physician will try to determine the extent (stage) of the cancer which in turn will help determine what treatment modalities will suit that specific stage of cancer. Treatment modalities for pancreatic cancer depend on the stage and the specific location of the cancer along with the overall health

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preferences. Treatment may include surgery, radiation, chemotherapy or a combination of these modalities.

Surgical oncologists, radiologists and other specialists treating pancreatic cancer patients will be reimbursed for their services. The screening tests and other procedures conducted as part of the treatment procedures must be correctly documented using the right medical codes. Using the medical billing services provided by a professional medical billing company can ensure this.

ICD-10-CM codes used to indicate a diagnosis of pancreatic cancer include – 

C25 - Malignant neoplasm of pancreas

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C25.0 - Malignant neoplasm of head of pancreas

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C25.1 - Malignant neoplasm of body of pancreas

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C25.2 - Malignant neoplasm of tail of pancreas

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C25.3 - Malignant neoplasm of pancreatic duct

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C25.4 - Malignant neoplasm of endocrine pancreas

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C25.7 - Malignant neoplasm of other parts of pancreas

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C25.8 - Malignant neoplasm of overlapping sites of pancreas

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C25.9 - Malignant neoplasm of pancreas, unspecified

According to the American Cancer Society, there is no specific way to prevent pancreatic cancer. However, incorporating healthy lifestyle habits like maintaining a healthy body weight, practicing regular body exercise, choosing a healthy diet (involving fruits, vegetables, and whole grains), consuming less red meat and quitting the habit of smoking can help prevent the risk of pancreatic cancer in the long run.

Medical billing and coding for pancreatic cancer can be complex, as there are several codes associated with the condition. By outsourcing these tasks to an established medical billing and coding company that offers the services of AAPC-certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.

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