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Provider Manual

Risk Adjustment - Cancer

Last Updated on June 17, 2019

Hierarchical Condition Category Coding and Cancer

Almost all diagnosed   active   cancers are associated with a hierarchical condition category code (HCC).  However,   “history of”  cancer is not associated with a HCC.  Thus, it is important that cancer is documented and coded accurately, following ICD-10 coding guidelines. 

When diagnosing cancer, it is important to include the following in documentation about cancer:

  • Location – Anatomic part of the body
    • Overlapping site boundaries
    • Multiple non-contiguous sites in same location
  • Type of lesion – histology or cell type if known
  • Behavior – document all that apply
    • Primary – cancer that arises from the cells found where the surgeon biopsies the neoplasm
    • Secondary/Metastatic – Cancer cells originated elsewhere and spread to this location. Documentation should clearly indicate the primary cancer and location of metastasis.
    • In situ – Malignancy confined to the site of origin without invasion of neighboring tissues.
  • Treatment – What is being done to eradicate the cancer, is it targeting the primary or secondary malignancy, any associated complications
    • Chemotherapy
    • Radiation therapy
    • Immunotherapy
    • Surgical intervention
    • Brachytherapy
    • Patient declines or is unable to have treatment

When diagnosing cancer, consider whether the cancer is active or the patient has a history of cancer:

  • “Active” cancer – Indicates a current, active diagnosis of cancer when any of the following exist:
    • The patient has evidence of current disease.
    • The patient is receiving treatment for cancer.  This includes current or long term therapies 
    • The patient did not receive definitive treatment for their malignancy
  •  “History of” cancer – The patient has successfully completed treatment for malignancy, has no current treatment for the condition and no evidence of the disease.


Brenda Anderson
Revenue Management Educator
Security Health Plan 
Telephone: 715-221-9598

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