ICD-10 Coding for Elevated Carcinoembryonic Antigen (CEA)(R97.0)
Complete ICD-10-CM coding and documentation guide for Elevated Carcinoembryonic Antigen (CEA). 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 (CEA)
R97.0Primary Range
Abnormal tumor markers
This range includes codes for abnormal findings of tumor markers, specifically elevated CEA.
Key Information: ICD-10 code for elevated CEA
Essential facts and insights about Elevated Carcinoembryonic Antigen (CEA)
Primary ICD-10-CM Code for elevated cost-effectiveness analysis
Decision Criteria
clinical Criteria
- Elevated CEA level with no confirmed malignancy
coding Criteria
- Use as secondary code with a primary malignancy code
Applicable To
- Elevated CEA levels
Clinical Validation Requirements
- Documented CEA level with units
- Reference range provided
- Clinical context such as smoking status
Code-Specific Risks
- Incorrectly using as a primary diagnosis
- Failure to document quantitative CEA level
Coding Notes
- R97.0 should not be used as a primary diagnosis code when a malignancy is confirmed.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of other malignant neoplasm of large intestine
Z85.038Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Malignant neoplasm of colon, unspecified
C18.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Elevated Carcinoembryonic Antigen (CEA) to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R97.0.
Impact
Clinical: Inadequate information for clinical decision-making., Regulatory: Non-compliance with documentation standards., Financial: Potential denial of claims due to insufficient documentation.
Mitigation Strategy
Always document CEA level with units, Include reference range
Impact
Reimbursement: May lead to incorrect DRG assignment and reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Always use a definitive diagnosis as primary if available.
Impact
Using R97.0 as a primary diagnosis when a malignancy is present.
Mitigation Strategy
Ensure primary diagnosis reflects the underlying 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 (CEA), with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Elevated Carcinoembryonic Antigen (CEA)
Use these documentation templates to ensure complete and accurate documentation for Elevated Carcinoembryonic Antigen (CEA). These templates include all required elements for proper coding and billing.
Oncology Progress Note
Specialty: OncologyRequired Elements
- CEA level with units
- Reference range
- Clinical context
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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