ICD-10 Coding for Cancer Antigen 125(R97.1, C56.9)
Complete ICD-10-CM coding and documentation guide for Cancer Antigen 125. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cancer Antigen 125
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R97.1 | Elevated cancer antigen 125 [CA 125] | Use when CA-125 is elevated and not directly linked to a confirmed malignancy. |
|
| C56.9 | Malignant neoplasm of ovary, unspecified | Use as a primary code when CA-125 is used for monitoring ovarian cancer. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for elevated CA-125
Essential facts and insights about Cancer Antigen 125
Primary ICD-10-CM Codes for cancer antigen 125
Decision Criteria
clinical Criteria
- Patient has elevated CA-125 with no confirmed malignancy.
coding Criteria
- Do not use R97.1 as a primary code for cancer monitoring.
Applicable To
- Elevated CA-125 without confirmed cancer
Excludes
- CA-125 used for screening purposes
Clinical Validation Requirements
- CA-125 level ≥35 U/mL
- Clinical context indicating monitoring or diagnosis of a condition
Code-Specific Risks
- Misuse as a primary code for cancer monitoring
Coding Notes
- Ensure documentation specifies the clinical context and CA-125 levels.
C56.9 - Malignant neoplasm of ovary, unspecified
Use as a primary code when CA-125 is used for monitoring ovarian cancer.
Applicable To
- Ovarian cancer
Excludes
- Benign ovarian tumors
Clinical Validation Requirements
- Histological confirmation of ovarian cancer
Coding Notes
Always sequence C56.9 before R97.1 when monitoring ovarian cancer.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cancer Antigen 125 to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R97.1.
Impact
Clinical: May lead to misinterpretation of test results., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to lack of justification.
Mitigation Strategy
Always include clinical indication in the patient's record., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Affects accuracy of cancer registry data.
Mitigation Strategy
Always sequence the malignancy code first, followed by R97.1.
Impact
R97.1 used as primary code for cancer monitoring.
Mitigation Strategy
Educate coders on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Cancer Antigen 125, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cancer Antigen 125
Use these documentation templates to ensure complete and accurate documentation for Cancer Antigen 125. These templates include all required elements for proper coding and billing.
Routine monitoring of ovarian cancer
Specialty: OncologyRequired Elements
- Patient history of ovarian cancer
- Current CA-125 levels
- Clinical context for testing
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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