Billing and Coding Liver Cancer – An Overview of the Condition and ICD-10 Codes

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Liver cancer is the growth and spread of unhealthy cells in the liver. Located in the right upper quadrant of the abdomen (right below the ribs), the liver is the largest glandular organ in the body that performs various critical functions to keep the body free of toxins and other harmful substances. The liver condition occurs when liver cells develop changes (mutations) in their DNA. A cell’s DNA is the material that provides instructions for every single chemical process in your body. The exact cause of liver cancer is unknown. However, most cases are linked to scarring of the liver (also referred to as cirrhosis) and chronic hepatitis infections. In fact, reports from the American Cancer Society suggest that, hepatitis C is the most common cause of liver cancer in the United States. Symptoms generally do not become visible in the early stages. Treatment modalities for this condition may vary, depending on the type of liver cancer. Physicians’ practices dealing with patients suffering from liver cancer need to know the ICD-10 codes to report this condition correctly. Opting for billing services from a reliable and established gastroenterology medical billing company would help in accurate and timely claim filing for appropriate reimbursement.

According to reports from Cancer.Net, an estimated 42,030 adults (29,480 men and 12,550 women) in the United States will be diagnosed with primary liver cancer (2019 statistics). It is estimated that men are about 3 times more likely to get liver cancer than women. Liver cancer is generally classified into two major types – primary and secondary. Primary liver cancer begins in the cells of the liver whereas secondary type develops when cancer cells from another organ spread to the liver. Primary liver cancer can start as a single lump growing in the liver, or it can start in many places within the liver at the same time. People with severe liver damage are more likely to have multiple cancer growth sites. Some of the common types of primary liver cancer include – Hepatocellular carcinoma, Liver angiosarcoma, Hepatoblastoma and Cholangiocarcinoma.

What Are the Symptoms of Liver Cancer?

Most people do not experience any specific symptoms in the early stages of primary liver cancer. The symptoms, in most cases, tend to get noticed in later stages when the condition becomes more advanced. Common symptoms include –

  • Abdominal discomfort, pain, and tenderness
  • White, chalky stools
  • Unexplained weight loss
  • Nausea and vomiting
  • Loss of appetite
  • Jaundice (yellowing of your skin and the whites of your eyes)
  • Itchy skin
  • General weakness and fatigue
  • Bruising or bleeding easily
  • Back pain
  • An enlarged liver

Liver cancer is more common in people above the age group of 50 years. There are several potential factors that increase the risk of primary liver cancer and these include – excessive alcohol consumption, non-alcoholic fatty liver disease, exposure to aflatoxins, diabetes, obesity, smoking and occurrence of certain inherited liver diseases (like hemochromatosis and Wilson’s disease).

Treatment Modalities

Initial diagnosis of this liver condition starts with a detailed physical examination and previous medical history evaluation. Physical examination will be done to check for swelling in the abdomen and any yellow coloring in the whites of the eyes that are strong indicators of liver problems. Physicians will recommend blood tests (to check for liver abnormalities) and tests for viral hepatitis (to check the presence of hepatitis B and C infections). Imaging tests such as Ultrasound, CT scan and MRI scan may also be performed. In addition, a liver biopsy is usually done – wherein a small sample of tumor tissue is removed and analyzed. The analysis can reveal whether the tumor is cancerous or non-cancerous. If the tumor is cancerous, these tests can assess the stage, location, and type of liver cancer.

Staging a cancer allows a physician to decide the further course of treatment. Liver cancer is categorized into four different stages –

  • Stage 1 – In this stage, the tumor is in the liver and has not spread to another organ or location.
  • Stage 2 – This stage involves two possibilities. There will be one tumor that has reached a blood vessel or there will be numerous tumors that all remain in the liver.
  • Stage 3 – There will be various large tumors or one single tumor that has reached the main blood vessels. Cancer may have also have spread to the gallbladder.
  • Stage 4 – During this stage, the cancer starts spreading to other parts of the body.

Determining the correct stage of liver cancer can help in deciding the further course of treatment. Treatment for primary liver cancer depends on the extent (stage) of the disease as well as other factors like patient age and overall health preferences.

For people who suffer from early-stage liver cancer (that can be treated), surgery will be an option that removes the tumor completely. Surgical options include partial hepatectomy and liver transplant surgery. On the other hand, advanced stage of liver cancer has low survival rates. Physicians can take steps to treat the symptoms and slow the growth of the tumor. These treatment options include ablative therapy, radiation therapy and chemotherapy. Hepatologists, Gastroenterologists and Oncology specialists who provide specialized treatment for liver cancer are reimbursed for the services provided to the patients. The correct medical codes must be used to document the diagnosis, screening and other procedures performed. Billing and coding services offered by reputable medical billing and coding companies can help physicians in using the correct codes for their medical billing process. Billable/specific ICD-10-CM codes that can be used to indicate a diagnosis of liver cancer for reimbursement purposes include –

  • C22 – Malignant neoplasm of liver and intrahepatic bile ducts
    • C22.0 – Liver cell carcinoma
    • C22.1 – Intrahepatic bile duct carcinoma
    • C22.2 – Hepatoblastoma
    • C22.3 – Angiosarcoma of liver
    • C22.4 – Other sarcomas of liver
    • C22.7 – Other specified carcinomas of liver
    • C22.8 – Malignant neoplasm of liver, primary, unspecified as to type
    • C22.9 – Malignant neoplasm of liver, not specified as primary or secondary

The survival rate for liver cancer is very poor, if diagnosed at an advanced stage – wherein the cancer has spread to other organs or other parts of the liver. As mentioned above, there are several risk factors for liver cancer – among them cirrhosis and hepatitis infections are the prominent ones. Preventing liver cancer requires careful steps to reduce the occurrence of cirrhosis (scarring of the liver) and avoiding from getting infected from hepatitis B and C infections. Maintaining a healthy body weight and stopping the habit of drinking can help prevent the incidence of liver cancer.

Gastroenterology medical billing and coding can be complex, as there are several codes associated with the condition. By utilizing medical billing and coding services from a reliable and established company that offers the services of AAPC-certified coding specialists, healthcare practices can ensure correct and timely medical billing and claims submission.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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