Elevated cancer antigen 125 [CA 125]

This code indicates an abnormally high level of cancer antigen 125 (CA-125) in the blood. CA-125 is a protein that can be elevated in various conditions, most notably certain cancers, but also in non-malignant gynecological and inflammatory conditions. It serves as a tumor marker, primarily for ovarian cancer.

This code is used when laboratory results confirm an elevated CA-125 level, and a definitive diagnosis for the underlying cause has not yet been established. It is appropriate for monitoring patients with known conditions that can cause CA-125 elevation or during initial workup for suspected malignancy. Documentation should clearly state the elevated CA-125 result and the lack of a confirmed primary diagnosis.

• Do not code this if a definitive diagnosis explaining the elevated CA-125 is already established; instead, code the definitive diagnosis.
• This code is often used as a secondary diagnosis when monitoring a patient for recurrence of a CA-125-producing tumor, even if no current recurrence is found.
• Always review the entire medical record to ensure no more specific diagnosis can be assigned.