ICD-10 Coding for Elevated Carcinoembryonic Antigen(R97.0)
Complete ICD-10-CM coding and documentation guide for Elevated Carcinoembryonic Antigen. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Elevated Carcinoembryonic Antigen
R97-R97.9Primary Range
Abnormal tumor markers
This range includes codes for abnormal findings of tumor markers, including elevated carcinoembryonic antigen.
Key Information: ICD-10 code for elevated carcinoembryonic antigen
Essential facts and insights about Elevated Carcinoembryonic Antigen
Primary ICD-10-CM Code for elevated carcinoembryonic antigen
Decision Criteria
clinical Criteria
- CEA level above 5 ng/mL for non-smokers or 10 ng/mL for smokers
documentation Criteria
- Documented clinical correlation with a known or suspected malignancy
Applicable To
- Abnormal CEA levels
Excludes
- Elevated tumor markers other than CEA (e.g., CA-125)
Clinical Validation Requirements
- Documented CEA level above normal range
- Clinical context indicating relevance (e.g., history of malignancy)
Code-Specific Risks
- Using R97.0 as primary for active cancer without supporting documentation
Coding Notes
- Ensure CEA levels and clinical context are documented to support coding.
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 Elevated Carcinoembryonic Antigen to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R97.0.
Impact
Clinical: Lack of specificity can lead to misinterpretation., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Always specify the type of tumor marker., Include exact values and clinical context.
Impact
Reimbursement: Incorrect sequencing can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Sequence the malignancy code first, followed by R97.0.
Impact
Coding R97.0 without a documented history of neoplasm can trigger audits.
Mitigation Strategy
Ensure documentation includes history or suspicion of malignancy.
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 Elevated Carcinoembryonic Antigen, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Elevated Carcinoembryonic Antigen
Use these documentation templates to ensure complete and accurate documentation for Elevated Carcinoembryonic Antigen. These templates include all required elements for proper coding and billing.
Oncology follow-up visit
Specialty: OncologyRequired Elements
- Patient history
- CEA levels
- Clinical correlation
- Physician interpretation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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