question

Malignant transverse of colon

answer

C18.4

question

Uncertain behavior of adrenal gland

answer

D44.10

question

Malignant neoplasm of lip

answer

C43.0

question

Carcinoma in situ of trachea

answer

D02.1

question

Unspecified behavior of bladder

answer

D49.4

question

Benign neoplasm of nasopharynx

answer

D10.6

question

Malignant neoplasm of sigmoid colon

answer

C7A.025

question

Morphology of neoplasms refers to the study of the from and structure of the tissue and cells from which the neoplasm arises

answer

True

question

Metastatic neoplasms can be identified by their morphology, which is identical to the morphology of the surrounding normal tissue and cells at the metastatic site

answer

False

question

Coders may use the completed cancer staging from for coding purposes when it is authenticated by the attending physician

answer

True

question

Bronchial adenoma

answer

D38.1

question

Burkitt lymphoma of intrapelvic lymph nodes

answer

C83.76

question

Lipoma of head

answer

D17.0

question

Hairy cell leukemia in remission

answer

C91.41

question

Endometrial sarcoma

answer

C54.1

question

Hodgkin sarcoma

answer

C81.90

question

Carcinoma of upper and middle third of esophagus

answer

C15.8

question

Carcinoma of oral cavity and pharynx

answer

C14.8

question

Adenocarcinoma of rectum and anus

answer

C21.8

question

Personal history of in situ neoplasm of breast

answer

Z86.000

question

Personal history of in situ neoplasm of cervix uteri

answer

Z86.001

question

Personal history of colonic polyps

answer

Z86.010

question

Personal history of benign neoplasm of the brain

answer

Z86.011

question

Personal history of benign carcinoid tumor

answer

Z86.012

question

Personal history of other benign neoplasm

answer

Z86.018

question

Personal history of neoplasm of uncertain behavior

answer

Z86.03

question

Metastatic carcinoma of right lung

answer

C34.91 C79.9

question

Metastatic carcinoma to brain

answer

C79.31 C80.1

question

Metastatic carcinoma from prostate to pelvic bone previous prostatectomy with no recurrence at primary site(Hint history)

answer

C79.51 Z85.46

question

Metastatic carcinoma to brain from lung Previous resection of lung with no recurrence at primary site (Hint history)

answer

C79.31 Z85.118

question

Metastatic carcinoma from prostate to pelvic bone

answer

C61 C79.51

question

Metastatic carcinoma of brain and lung

answer

C79.31 C78.00 C80.1

question

Metastatic carcinoma of pancreas and omentum

answer

C78.89 C78.6 C80.1

question

Metastatic adenocarcinoma of transverse colon

answer

C18.4 C79.9

question

Metastatic carcinoma of bronchus

answer

C34.90 C79.9

question

Metastatic carcinoma of spinal cord

answer

C79.49 C80.1

question

Metastatic carcinoma of femur

answer

C79.51 C80.1

question

Metastatic carcinoma of brain

answer

C79.31 C80.1

question

Metastatic serous papillary adenocarcinoma of bone

answer

C56.9 C79.51

question

Metastatic infiltrating duct cell carcinoma, female

answer

C50.919 C79.9

question

Metastatic odontogenic fibrosarcoma

answer

C41.1 C79.9

question

Chondroblastic osteosarcoma of limb with metastasis

answer

C40.90 C79.9

question

Aleukemic myeloid leukemia in remission

answer

C92.z1

question

Reticulum cell sarcoma of the spleen

answer

C83.37

question

Sarcoma, reticulum cell , intrathoracic

answer

C83.32

question

Intrapelvic Hodgkin granuloma

answer

C81.96

question

Chronic myeloid lekemia

answer

C92.10

question

Plasma cell leukemia

answer

C90.10

question

Carcinoma of lung with metastatic

answer

C34.90 C77.1

question

Mycosis fungoides of intrathoracic and intra abdominal lymph nodes

answer

C84.08

question

Chlamydial lymphogranuloma

answer

A55

question

Adenolymphoma of left female breast

answer

D24.2

question

Diffuse large B cell lymphoma intra abdominal

answer

C83.33

question

Peripheral T cell lymphoma neck

answer

C84.41

question

The recurrence of an original primary malignant neoplasm that was previously removed is classified to category Z85, personal history of malignant neoplasm.

answer

False

question

If a primary malignant neoplasm was excised previously and the original primary site has not recurred, assign the code for the previous primary malignant neoplasm, using the appropriate code from categories C00 through D49

answer

False

question

Whenever secondary neoplasms are present, the Z code for identifying personal history of malignant neoplasm can never be sequenced as the principal diagnosis code for Uniform Hospital Discharge Data Set purposes.

answer

True

question

Infiltrating papillary transitional cell carcinoma of urinary bladder (neck)

answer

C67.5

question

Carcinoma of midesophagus with spread to celiac lymph nodes

answer

C15.4 C77.2

question

Malignant carcinoid tumor of small intestine

answer

C7A.019

question

Carcinoma , scirrhous, female left breast, outer portion

answer

C50.812

question

Intramural leiomyoma of uterus

answer

D25.1

question

Multiple myeloma

answer

C90.00

question

Carcinoma of gallbladder with metastasis to abdominal lymph nodes and liver and peritoneal implants

answer

C23 C77.2 C78.7 C78.6

question

Squamous cell carcinoma in situ, floor of mouth

answer

D00.06

question

Metastatic malignant melanoma from left lateral chest wall to axillary lymph node

answer

C43.59 C77.3

question

Lipoma, right kidney

answer

D17.71

question

Metastatic adenocarcinoma of sacrum, prostatic in origin previous prostatectomy

answer

C79.51 Z85.46

question

Seminoma, left testis

answer

C62.92

question

Chronic lymphocytic leukemia (B cell) , in remission

answer

C91.11

question

A 33 year old female admitted for prophylactic removal of both breasts, with documented genetic susceptibility to breast cancer due to extensive family history of breast carcinoma

answer

Z40.01 Z15.01 Z80.3

question

Carcinoma of left ovary

answer

C56.2

question

Patient was diagnosed with right lung cancer

answer

C34.91

question

Coding Neoplasms

answer

First axis:Behavior Second axis: Anatomical site Neoplasms are classified into five behavior groups: Malignant: C00-C75, C76-C96 Neuroendocrine: C7A-C7B, D3A Carcinoma in situ: D00-D09 Benign: D10-D36 Uncertain behavior: D37-D48 Unspecified behavior: D49

question

Malignant Neoplasms

answer

Characteristics of malignant neoplasms: Tumor cells extend beyond the primary site Attach to adjacent structures Spread to distant sites Have aggressive growth Invasive—extension of tumor cells to adjacent sites Invasion or spread referred to as metastasis

question

Invasive Neoplasm

answer

Malignant neoplasm (for example, malignant melanoma of skin): Requires excision beyond the tumor site.Biopsy finding of malignancy requires further surgery. Surgical pathology report may not show malignancy. Malignancy is coded based on the initial findings.Treatment of malignancy is the reason for admission.Copy original pathology report and file with the record.

question

Neuroendocrine Tumors

answer

Categories C7A-C7B and D3A classify neuroendocrine tumors: The tumors arise from endocrine or neuroendocrine cells scattered throughout the body. Common sites include the bronchi, stomach, small intestine, appendix, and rectum. Classified according to the presumed embryonic site of origin, such as:Foregut (bronchi and stomach)Midgut (small intestine and appendix)Hindgut (colon and rectum) Carcinoid tumors develop from enterochromaffin cells: These cells produce hormones normally found in intestines, appendix, rectum, bronchi, pancreas, ovaries, testes, bile ducts, liver, or other organs. Carcinoid tumors can produce the same hormones in larger quantities: Can lead to carcinoid syndrome (E34.0). 25% of carcinoid tumors are found in the bronchial airways and lungs. Not always possible to locate the site of origin of the carcinoid tumors.

question

Neuroendocrine Tumors (cont.)

answer

Carcinoid tumors present as: Primary malignancy (category C7A) Secondary or metastatic tumor (category C7B) Benign tumor (category D3A) Category Z85: Assign these codes to describe a patient with history of malignant neuroendocrine tumor that was previously excised or eradicated, with no further treatment.Code also multiple endocrine neoplasia (MEN) syndrome (E31.20-E31.23) when associated with neuroendocrine tumors. Do not code MEN syndrome if the health record does not support the condition. Assign codes from subcategory E31.2, Multiple endocrine neoplasia [MEN] syndromes, only when MEN syndrome is actually present.

question

Merkel Cell Carcinoma

answer

Merkel cell carcinoma (neuroendocrine carcinoma of the skin): Arises from the uncontrolled growth of Merkel cells in the skin Rare type of skin cancer Potentially life-threatening Aggressive therapy required No distinguishing appearance Usually develops on sun-exposed skin (e.g., head, neck and arms) Diagnosed via skin biopsy

question

Malignant Neoplasms of Ectopic Tissue

answer

Such neoplasms are coded to the origin mentioned in the documentation. For example, ectopic pancreatic malignant neoplasms involving the stomach are coded to C25.9, Pancreas, unspecified.

question

Benign Neoplasms

answer

Characteristics: Not invasive Do not spread to adjacent or distant sites Local effects can include: Displacement Pressure on adjacent structure Nerve impingement Vessel compression Require surgery for total excision

question

carcinoma in situ.

answer

Characteristics: Tumor cells undergoing malignant changes. Cells confined to the point of origin. Not invasive to surrounding tissue. Other terms describing carcinoma in situ: Intraepithelial Noninfiltrating Noninvasive Preinvasive carcinoma Classify severe cervical or vulvar dysplasia (CIN III or VIN III) as carcinoma in situ.

question

Neoplasm of Uncertain Behavior

answer

Behavior of certain neoplasms cannot be determined: No firm distinction between benign and malignant tumor cells can be made. Because tumors may be undergoing malignant transformation, further study required to confirm diagnosis.

question

Neurofibromatosis

answer

Neurofibromatosis: A group of autosomal dominant genetic disorders that cause tumors to grow along the nerves. Assign code Q85.00, Unspecified neurofibromatosis Schwannomas: Can occur along any nerve of the body, including spinal, cranial, and peripheral nerves (except on the vestibular nerve). When tumors enlarge, they compress nerves. Assign code Q85.03, Schwannomatosis

question

Neoplasm of Unspecified Behavior

answer

Category D49 captures unspecified behavior and morphology of tumors. Normally not used in an acute-care facility. More definitive information should be available. Do not confuse neoplasm of unspecified behavior with neoplasm of uncertain behavior.Dark areas or spots on the retina are exceptions to coding neoplasm of unspecified nature. Dark areas or spots on the retina are also called neoplasms or "suspected melanoma." Difficult to biopsy and must be constantly evaluated. Biopsy of the retina poses a risk to the eye. Biopsy only performed if the lesion extends. Generally, no tissue biopsy is performed to confirm the diagnosis. Assign code D49.81, Neoplasm of unspecified behavior, retina and choroid, for dark spots on the retina.

question

Unspecified Mass or Lesion

answer

When coding mass or lesion of a particular site not listed under "Mass" or "Lesion": Follow cross-references under the main term for the documented diagnosis. For example, a diagnosis of "lump" with no index entry for the site under "Lump": Look up the main term "Mass." If no index entry under "Mass," see "Disease." Index directs to see Disease of specified organ or site for Mass, specified organ NEC.

question

Morphology Classification

answer

Morphology of neoplasms: Refers to the form and structure of tumor cells. Studied to classify a neoplasm by its tissue of origin. The tissue of origin and the type of cells often determine: The expected rate of growth, The severity of illness, and The type of treatment given. Metastatic neoplasms are identified at the metastatic site by their morphology.

question

Tumor Registry

answer

Cancer data system that provides follow-up on all cancer patients: Registry documents and stores all major aspects of a patient's cancer history and treatment. Database includes demographics, medical history, diagnostic findings, primary site, metastasis, histology, stage of disease, treatments, recurrence, subsequent treatment, and end results. Coders may use the completed cancer staging form for coding purposes when it is authenticated by the attending physician. If staging classes are documented in the medical record, obtain copies of the current classifications to use for decoding the numerical/alphabetical designations.

question

Steps for Locating Neoplasm Codes

answer

Refer to the main term for the morphological type in the Alphabetic Index: Review the subentries. For some neoplasms, the diagnosis code is provided. Renal cell carcinoma is listed in the Alphabetic Index under the main term, Carcinoma, and the subterm renal cell, as follows: Carcinoma ... renal cell C64.- If site not listed as a subterm or a specific code is not provided in the index, a cross-reference to the Neoplasm Table is provided. Follow all Index cross-references closely. Example: Sarcoma ... cerebellar C71.6 embryonal—see Neoplasm, connective tissue, malignant Ewing's—see Neoplasm, bone, malignant

question

Neoplasm Table

answer

Neoplasm Table: Lists anatomical sites alphabetically on the far left. Columns to the right indicate behavior type. To use the Table: Locate the anatomical site on the Table. Move across the page to the behavior type. Select the appropriate code. Verify code selection in the Tabular List.

question

Types of Malignant Neoplasms

answer

Two basic types: Solid neoplasms (C00-C75, C76-C80). Hematopoietic and lymphatic neoplasms (C81-C96). Characteristics of solid tumors: Single, localized point of origin. Primary tumor of that site. Can spread to adjacent or remote sites. Invasive spread is classified as secondary or metastatic.Characteristics of lymphatic and hematopoietic neoplasms: Arise in reticuloendothelial and lymphatic systems and blood-forming tissues. Can develop in a single site or several sites simultaneously. Tumor cells can circulate in large numbers in the bloodstream and the lymphatic system: Not confined to a single site. Spread to other sites in the hematopoietic and lymphatic system. Spread is not considered metastatic; it is also classified as primary neoplasm.

question

Metastatic Neoplasms

answer

Solid malignant neoplasms can spread by: Direct extension, or Metastasis. Direct extension refers to: Invasion to adjacent sites. Metastasis refers to: Spread to distant sites, and Establishment of new center of malignancy Terms "metastatic" and "secondary" are used interchangeably.

question

Overlapping Sites

answer

If point of origin of solid malignant neoplasm is not determined due to overlapping boundaries of two or more contiguous sites: Classify with fourth digit "8" unless the combination is specifically indexed elsewhere. ICD-10-CM provides codes for certain malignant neoplasms whose stated sites overlap boundaries, including: C16.8, Neoplasm of stomach whose point of origin cannot be assigned to any other code within category C16 C34.80, Neoplasm of overlapping sites of lung, bronchus, and trachea whose point of origin cannot be assigned to any other code within category C34 If there are multiple neoplasms of the same site but they are not contiguous, assign a code for each site.

question

Malignancy in Two or More Noncontiguous Sites

answer

More than one malignant tumor in the same organ: May represent different primary cancers or metastatic disease. Synchronous primary cancers: More than one primary cancer in same organ. Physician must make designation whether a second primary malignancy or metastasis has occurred.

question

Metastasis

answer

"Metastatic" and "metastasis" are used ambiguously to describe neoplastic disease: Could refer to primary site. Could refer to secondary site. If the diagnostic statement is unclear, review record for further information. "Metastatic to" indicates secondary site. For example: Metastatic carcinoma to the lung: Assign C78.0, Secondary malignant neoplasm lung. Code also primary neoplasm, if present. Assign code from history category Z85, Personal history of malignant neoplasm, if the primary neoplasm is excised or eradicated. "Metastatic from" indicates primary site. If two or more metastatic sites are described: Each site is coded as secondary or metastatic. Assign also code for primary site, if information is available. Assign code C80.1, if information about primary site is not available.

question

Metastasis (cont.)

answer

When coding a site described as metastatic without further qualification and definitive information is not available: Refer first to the morphology type in the Alphabetic Index. Code to the primary condition of that site. When a specific site for the morphology type is not in a code entry or Index: Assign the code for unspecified site within that anatomical site.

question

Metastasis (cont.2)

answer

If morphology type not stated, or only C80.0 or C80.1 is available, assign code for primary malignant neoplasm—unless the site is one of the following:Brain,Diaphragm, HeartBone, Liver, bone, Lymph nodes, Mediastinum, Meninges Peritoneum, Pleura, Retroperitoneum, Spinal cord Sites classifiable to C76.Malignant neoplasms of these sites are classified as secondary when not otherwise specified. Exception: Neoplasm of the liver—report code C22.9, Malignant neoplasm of liver, not specified as primary or secondary.

question

Metastatic Site Unspecified

answer

If site is not indicated, but the morphology type is metastatic: Assign the code provided for morphological type, and Assign code for secondary neoplasm of unspecified site. Example: Metastatic apocrine adenocarcinoma, site not specified. Assign code C44.99, Primary malignant neoplasm of the skin, and Assign code C79.9 for the unspecified secondary neoplasm. Code C44.99 is referenced as follows in the Index: Adenocarcinoma ... apocrine ... unspecified site C44.99

question

Lymphatic and Hematopoietic Neoplasms

answer

Neoplasms of lymphatic and hematopoietic tissues: Do not spread to secondary sites. Malignant cells circulate in tissue. Can occur in other sites within these tissues. Classified as primary neoplasms, not secondary neoplasms.

question

Neoplasms of Lymph Nodes

answer

Primary malignant neoplasms of lymph nodes or glands (categories C81-C88): Fourth character describes type of neoplasm. Fifth character indicates the nodes involved. Fifth character "8" indicates involvement of lymph nodes or glands of multiple sites. Example: Report code C83.38, Diffuse large B-cell lymphoma, lymph nodes of multiple sites, for diffuse large B-cell lymphoma of intra-abdominal and intrathoracic lymph nodes. Do not assign separate codes for different sites.When solid tumors metastasize to lymph nodes: Assign code from category C77. Example: For adenocarcinoma of breast with metastasis to axilla lymph nodes, assign C50.911 and C77.3. Categories C81 through C88 are not assigned. Lymphomas can be malignant or benign. Benign: Found by site in the Neoplasm Table. Malignant: Found in the Alphabetic Index by referencing subterms for the site under the main term Lymphoma.

question

Hodgkin Lymphoma

answer

Originates from lymphocytes and involves: Orderly spread of disease from one lymph node group to another; and Development of systemic symptoms with advanced disease. Treated with radiation therapy, chemotherapy, or hematopoietic stem cell transplantation. Approach depends on patient's age and sex and the stage, bulk, and histological subtype of the disease. Assigned to category C81: Fourth character identifies pathological subtype. Fifth character identifies lymph nodes involved.

question

Non Hodgkin Lymphoma

answer

Heterogeneous group of malignant lymphomas with clinical picture broadly similar to Hodgkin disease, without giant Reed-Sternberg cells characteristic of Hodgkin disease. Lymphomas develop from lymphoid components of the immune system. Many different subtypes of non-Hodgkin lymphomas based on chemical and genetic characteristics. Divided into: Aggressive (fast-growing) Indolent (slow-growing) Formed from either B-cells or T-cells.Follicular lymphoma (category C82) is the most common of the indolent non-Hodgkin lymphomas. Second most common form of non-Hodgkin lymphomas overall. Defined as a lymphoma of follicle center B-cells. Category C82 utilizes a dual-axis classification. Allows the classification of follicular lymphoma according to morphological grades or description of the follicle. Non-follicular lymphoma is classified to category C83.

question

Multiple Myeloma, Other Immunoproliferative Neoplasms, and Leukemias

answer

Multiple myeloma and other immunoproliferative neoplasms (C90): Fourth character indicates type of neoplasm. Leukemias (C91-C95): Fourth character indicates stage of the disease (acute or chronic) or type of leukemia (e.g., adult T-cell). For codes in categories C90-C95, the fifth character indicates: 0 Not having achieved remission (failed remission) 1 In remission 2 In relapse

question

Multiple Myeloma, Other Immunoproliferative Neoplasms, and Leukemias (cont.)

answer

Report fifth character "0" if the health record documentation does not indicate that the patient has achieved remission. When the provider documents that the malignancy is in remission, assign fifth character "1." If the patient experiences a recurrence, and the provider documents "relapse," assign fifth character "2." Relapse or recurrence can occur anytime during therapy or after completion of treatment, months or years after remission. Fifth characters indicating remission are used only when the physician specifically documents it as such. Important not to confuse "in remission" with personal history.

question

Designation of Principal Diagnosis

answer

Designation of principal diagnosis is the same for neoplasms as for any other condition: Principal diagnosis is the condition found after study to occasion the admission. No guideline states that malignancy takes precedence. Thrust of treatment can be used as a guide to select principal diagnosis. Some neoplasms affect the activity of endocrine glands. Assign the code for the primary neoplasms first. Assign also the code for associated endocrine gland dysfunction.

question

Designation of Principal Diagnosis (cont.)

answer

When the treatment is directed toward the primary site: Malignancy of that site is designated as the principal diagnosis. If patient admission/encounter is solely for radiation therapy, immunotherapy, or chemotherapy: Primary malignancy is sequenced second. When two primary sites are present: Each site is coded as a primary neoplasm. If treatment is directed toward one site, neoplasm of that site is the principal diagnosis. If treatment is directed equally toward both sites, either site may be designated as principal diagnosis. If patient is admitted for surgery to correct a nonneoplastic condition but pathology report indicates a microscopic focus of malignancy is also present: Condition that occasioned the admission is the principal diagnosis. Assign an additional code for the malignancyPatient admitted with primary neoplasm and metastasis: If treatment is directed solely toward the metastatic site: Secondary site is designated as the principal diagnosis, although the primary malignancy is still present. Assign also a code for the primary malignancy. If treatment is directed equally toward primary and secondary sites: Primary malignancy is designated as principal diagnosis. Assign an additional code for the secondary neoplasm.

question

Chemotherapy, Immunotherapy, or Radiation Therapy

answer

For patient admission/encounter solely for chemotherapy, immunotherapy, or radiation therapy, assign as principal or first-listed code: Z51.0 Encounter for antineoplastic radiation therapy Z51.11 Encounter for antineoplastic chemotherapy Z51.12 Encounter for antineoplastic immunotherapy If patient develops complications, such as uncontrolled nausea or vomiting or dehydration, while admitted for therapy: Assign the therapy code first. Codes for the complications follow.If patient receives more than one type of therapy during the same admission: Assign unique codes for the different therapies, in any sequence. If patient is under treatment for malignant neoplasm previously excised: Code the malignancy. (Do not use history code—Z85.) Assign procedure codes for radiation therapy, immunotherapy, or chemotherapy provided.

question

Tumor Lysis Syndrome

answer

Group of serious, potentially life-threatening metabolic disturbances. Occurs following antineoplastic therapy. Can result from radiation or corticosteroid therapy. Associated with leukemias and lymphomas. Also found in other hematologic malignancies and solid tumors. Assign code E88.3, Tumor lysis syndrome. If drug-induced, follow with code T45.1x5- to identify the cause.

question

Encounter to Determine Extent of Malignancy

answer

If admission/encounter is to determine extent of malignancy, or for paracentesis or thoracentesis: Assign the primary malignancy or appropriate metastatic site as the principal or first-listed diagnosis, even though chemotherapy or radiotherapy is administered.

question

Current Malignancy vs. Personal History of Malignancy

answer

If primary malignancy has been excised but further treatment is directed to that site: The primary malignancy code should be used until treatment is completed. Codes from category Z85, Personal history of malignant neoplasm, are assigned: Only when the primary neoplasm has been previously excised or totally eradicated from its site. The primary neoplasm is no longer under any type of treatment. There is no evidence of any existing primary malignancy. This guideline applies to both solid and hematopoietic or lymphatic neoplasms, including leukemia.

question

Malignant Neoplasm Associated with Transplanted Organ

answer

A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign a code from category T86.-, Complications of transplanted organs and tissue, as the principal diagnosis Follow with code C80.2, Malignant neoplasm associated with transplanted organ. An additional code is assigned for the specific malignancy.

question

Malignant Neoplasm in Pregnant Patient

answer

Assign a code from subcategory O9A.1-, Malignant neoplasm complicating pregnancy, childbirth, and the puerperium, first. The appropriate code from chapter 2, to indicate the type of neoplasm, is assigned as an additional code. Codes from chapter 15 of ICD-10-CM, Pregnancy, Childbirth, and the Puerperium, are always sequenced first on a medical record.

question

Pathological Fracture Due to Neoplasm

answer

Sequencing depends on the focus of treatment, as follows: If the focus of treatment is the fracture: A code from subcategory M84.5 is sequenced first. Follow with the code for the neoplasm. If the focus of treatment is the neoplasm with an associated pathological fracture: The neoplasm code is sequenced first. Follow with a code from M84.5 for the pathological fracture.

question

Malignant Ascites

answer

Malignant ascites (R18.0) is the abnormal buildup of fluid in the abdomen due to malignancy. Diagnostic tests commonly used to determine underlying cause involve: Blood tests Ultrasound of the abdomen Paracentesis Treatment may include: Diuretics, Therapeutic paracentesis (needle aspiration of the peritoneal cavity; code 0W9G3ZZ), or Therapy directed at the underlying cause.

question

Malignant Pleural Effusion

answer

Occurs due to impaired pleural lymphatic drainage from a mediastinal tumor (especially in lymphomas). Not due to direct tumor invasion into the pleura. Lymphoma is obstructing the drainage system. Caused by disturbance of the normal Starling forces regulating reabsorption of fluid in the pleural space, via obstruction of mediastinal lymphatics draining the parietal pleura. Report the malignancy first. Assign malignant pleural effusion (J91.0) as an additional diagnosis.

question

Prophylactic Organ Removal

answer

For encounters for prophylactic removal of breasts, ovaries, or other organ due to genetic susceptibility to cancer or a family history of cancer: Assign subcategory Z40, Encounter for prophylactic surgery, as the principal or first-listed diagnosis. Assign also the appropriate genetic susceptibility and family history code as additional diagnoses. If patient with malignancy of one site undergoes prophylactic removal of another site: Assign the malignancy code. Additionally assign a code from subcategory Z40. Do not assign code Z40.0- if the patient has organ removal for treatment of a malignancy.

question

Follow-Up Examinations

answer

After a malignant neoplasm has been excised or eradicated, periodic follow-up examinations are carried out to determine recurrence or spread to a secondary site. If there is no evidence of recurrence at the primary site or metastasis: Assign code Z08, Encounter for follow-up examination after completed treatment for malignant neoplasm, as the principal diagnosis. Assign code from category Z85 as an additional code. Assign additional code to identify any acquired absence of organs—Z90.- Assign codes for any diagnostic procedures (such as endoscopy and biopsy) that are carried out.

question

Treatment of Neoplasms

answer

Consists of: Surgery Generally involves removal of the neoplasm Chemotherapy Radiation therapy Other cancer treatment methods

question

Sequencing of Codes for Complications Due to Malignancy or Therapy (cont.)

answer

When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia: The anemia is sequenced first. For antineoplastic chemotherapy induced anemia, assign code D64.81. Code for the neoplasm is assigned as additional code. Adverse effect code is assigned as additional code (T45.1x5-).When the admission/encounter is for management of an anemia associated with an adverse effect of radiotherapy: The anemia is sequenced first. Assign an additional code for the neoplasm. Assign code Y84.2 as an additional code.

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