In this blog post, let’s talk about Neoplasms. Sounds like something out of Ghostbusters, doesn’t it? Chapter 2 of the ICD-10-CM official guidelines deals with general coding guidelines for correct ICD-10 code assignment for neoplasm conditions, neoplasm related conditions as well as neoplasm treatment-related complications. This chapter contains more than 1,540 codes found in categories C00–D49. Most benign and all malignant neoplasm codes are found in chapter 2 of ICD-10-CM. For coders to properly code a neoplasm, the medical record must include documentation as to whether the neoplasm is: Benign, Malignant, In situ, or Uncertain behavior. The correct assignment of the ICD-10-CM code for neoplasm depends on the reason for the visit. If the reason for the visit is for treatment directed at the malignancy, the malignancy code is designated as the principal or first-listed diagnosis. However, if a patient is admitted solely for the administration of chemotherapy, immunotherapy, or radiation therapy, assign a code from category Z51 as the principal diagnosis and the malignancy as the secondary diagnosis. Let’s go over an example, A patient with lung cancer of right upper lobe presents for radiation therapy today. Since the patient presented for treatment the codes would be, in order: Z51.0 - Encounter for antineoplastic radiation therapy will be reported as the primary code followed C34.11 - Malignant neoplasm of upper lobe, right bronchus or lung to identify cancer. With neoplasms, there are high chances that the primary malignant neoplasm may have two or more contiguous overlapping sites, in such situations coders should classify the sites to the subcategory/code with .8 (for overlapping sites) unless the combination is specifically indexed elsewhere. For example, the patient presents with a primary malignant tumor in the splenic flexure and transverse colon then C18.8 is the correct code to report the condition. In certain advanced circumstances if cancer becomes malignant and cancer from a primary site metastasize to a secondary site, both the cancers can be treated separately. In such circumstances, the proper assignment of primary ICD-10-CM code again depends upon the cancer being treated. Designate the secondary site neoplasm as the principal diagnosis when the treatment is directed only toward the secondary (metastatic) neoplasm even though the primary site is still present. If the treatment is directed equally toward both the primary and secondary sites, assign the primary malignancy as the principal diagnosis. Let's go over this scenario with an example:A patient has a primary malignancy in the right renal pelvis, it has now metastasized to the right ureter. The reason for today’s visit is the treatment of the cancer of ureter. Although the cancer of ureter is secondary cancer in this case, since the patient presented for treatment of the secondary site only, C79.19 - Secondary malignant neoplasm of other urinary organs should be first listed diagnosis followed by C65.1 - Malignant neoplasm of right renal pelvis as the second listed diagnosis. In addition to above, there are several complications associated with the malignancies as well as the therapy used for the treatment of malignancies. These complications again are reported based on the reason for the visit. Anemia is listed as one of the most common complications of malignancy and malignancy related treatments. It should be noted that guidelines for reporting treatment of anemia related to neoplasm are a bit different than the guidelines for reporting other complications related to malignancy and malignancy related treatments. In this, if there is an encounter for management of anemia associated with the malignancy and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the primary or first-listed diagnosis followed by the appropriate code for the anemia being treated listed as the secondary diagnosis. For all other complications of malignancy and malignancy related treatments, if the encounter is for management of complications related to neoplasm the ICD-10-CM code for that complication is reported as the primary or first-listed diagnosis followed by the ICD-10-CM code for the malignancy listed as the secondary diagnosis. Dehydration is also one of the several complications related to malignancies. When the admission is for the management of dehydration due to the malignancy or the therapy and only the dehydration is being treated, the ICD-10-CM code for dehydration is sequenced first followed by the code for the malignancy. Treatment of neoplastic conditions includes the use of radiotherapy, immunotherapy, or chemotherapy, and surgical excision. When the patient is being admitted for the surgical removal of a malignancy followed by chemotherapy or radiation therapy, the code for the malignancy is listed as the principal diagnosis. If the patient is admitted solely for the purpose of receiving chemotherapy, immunotherapy, or radiotherapy, sequence code Z51.11 (Admit for chemotherapy), Z51.12 (Admit for immunotherapy), or Z51.0 (Admit for radiotherapy) as the principal diagnosis. If the patient is admitted for determining the extent of the malignancy (staging) or for a procedure such as a thoracentesis or a paracentesis the ICD10-CM-code for malignancy (either the primary or secondary) should be sequenced as the principal diagnosis. Sometimes neoplasm can occur in a transplanted organ and if the reason for a visit is to treat the neoplasm of transplant organ, in such scenarios a code from subcategory T86 - Complications of a transplanted organ, and code C80.2 - Malignant neoplasm associated with transplanted organ should be reported. A code for the specific malignancy is also reported to identify the malignancy. When the patient is admitted with a nonneoplastic condition for chemotherapy or immunotherapy, assign the condition as the principal diagnosis. Do not assign code Z51.11 or Z51.12. For example, a patient is admitted for chemotherapy to treat macroglobulinemia. Assign code C88.0; do not assign code Z51.11 because the main reason for the visit is to treat the macroglobulinemia. Assign a code for the malignancy if a patient is receiving treatment (eg, chemotherapy) for a malignancy that has already been excised. Do not assign a code from category Z85, Personal history of malignant neoplasm, because the patient would not still be under treatment if the malignancy was a history of malignancy. Keep in mind, cancer treatment is not inclusive of surgery, radiation therapy, and chemotherapy. Physicians are often continuing a patient’s treatment with immunotherapy, targeted therapy, and/or precision medications. Coders often overlook these ongoing therapies as a cancer treatment. When a primary malignancy has been previously excised or eradicated from its site and there is no treatment directed at that site with no evidence of any remaining malignancy at the primary site, the appropriate code from category Z85, Personal history of malignant neoplasm, to indicate the former site of the primary malignancy should be reported. Documentation of the extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The metastatic site may be sequenced as the principal diagnosis if the treatment is directed toward the metastatic site. In conclusion, it should be fair to say that a thorough review of the complete medical record documentation needs to be carried out carefully by the coder/auditor in order to concisely assign and sequence the most accurate ICD-10-CM code for the malignancy/complication being treated keeping in mind all the additional instructions and guidelines listed in the Section 1.C.2 of ICD-10-CM official guidelines. Download this article and its bundle here.
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October 27, 2008  Neoplasm Guidelines The ICD-9-CM Official Guidelines for Coding and Reporting was updated effective October 1, 2008. The neoplasm guidelines, among others, were updated. Coders often have questions about the coding and proper sequencing of neoplasms, so below is a summary of the common neoplasm rules and guidelines. Neoplasm Coding Guidelines • Designate the secondary site neoplasm as the principal diagnosis when the treatment is directed only toward the secondary (metastatic) neoplasm even though the primary site is still present. If the treatment is directed equally toward both the primary and secondary sites, assign the primary malignancy as the principal diagnosis (AHA ICD-9-CM Coding Handbook, Faye Brown, 2004, page 300). • Sequence anemia as the principal diagnosis when the admission is for the management of anemia associated with the malignancy or the therapy and the treatment is only directed at the anemia. The anemia code assignment will depend on the specific type of anemia documented. Code 285.22, Anemia in neoplastic disease, is used for anemia due to malignancy. Do not use code 285.22 for anemia that is due to antineoplastic chemotherapy drugs. • Sequence dehydration as the principal diagnosis when the admission is for the management of dehydration due to the malignancy or the therapy and only the dehydration is being treated. • When the admission is for the treatment of a complication resulting from a surgical procedure, sequence the complication as the principal diagnosis if treatment is directed at resolving the complication. • When the primary malignancy has been previously excised or eradicated from its site and there is no adjunct treatment directed at that site and no evidence of any remaining malignancy at the primary site, use the appropriate code from category V10, Personal history of malignant neoplasm, to indicate the former site of the primary malignancy. Documentation of the extension, invasion, or metastasis to another site is coded as a secondary malignant neoplasm to that site. The metastatic site may be sequenced as the principal diagnosis if treatment is directed toward the metastatic site. • Sequence the malignancy as the principal diagnosis when the patient is admitted for the surgical removal of a malignancy followed by chemotherapy or radiation therapy. If the patient is admitted solely for the purpose of receiving chemotherapy, immunotherapy, or radiotherapy, sequence code V58.11 (Admit for chemotherapy), V58.12 (Admit for immunotherapy), or V58.0 (Admit for radiotherapy) as the principal diagnosis. • Sequence the malignancy (either the primary or secondary) as the principal diagnosis if the patient is admitted to determine the extent of the malignancy (staging) or for a procedure such as thoracentesis or paracentesis even though chemotherapy or radiation therapy is administered. • Sequence the malignancy as the principal diagnosis when the patient is admitted with signs and symptoms related to the malignancy. • A malignant neoplasm of a transplanted organ is assigned to a code from subcategory 996.8, Complications of a transplanted organ, and code 199.2, Malignant neoplasm associated with transplanted organ. Also, assign a code for the specific malignancy. Other Neoplasm Coding Directives • If the patient is admitted for a radioactive implant, assign the malignancy as the principal diagnosis; do not assign code V58.0. • Assign a code for the malignancy if a patient is receiving treatment (eg, chemotherapy) for a malignancy that has already been excised. Do not assign a code from category V10, Personal history of malignant neoplasm, because the patient would not still be under treatment if the malignancy were actually a history of malignancy. Coding and sequencing for neoplasms are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447. |
When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary neoplasm only?
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