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Coding Guidelines

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ICD-9-CM Official Guidelines for Coding and Reporting: See Appendix I on CD-ROM in textbook Chapter-specific guidelines exist for coding of neoplasms (140-239), primary and secondary sites, complications, V10 for personal history, admissions for therapy or to determine the extent of the malignancy, and sign and symptom codes Chapter-specific guidelines exist for the coding of neoplasm-related pain (338.3)

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Criteria for Classification with ICD-9-CM

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Behavior Malignant Benign Anatomical Site Morphology type Leukemia Melanoma Adenocarcinoma

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Behavior of Neoplasms

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Malignant Neoplasms - collectively referred to as cancers Can invade and destroy adjacent structures as well as spread to distant sites

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Behavior of Neoplasms (continued)

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Malignant Neoplasms Primary: site where neoplasm originated Secondary: site to which neoplasm has spread (also known as the metastatic site) In situ: malignant changes in cells but surrounding tissue has not been invaded

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Behavior of Neoplasms (continued) b

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Benign neoplasms: tumor growth does not invade adjacent structures or spread to distant sites

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Behavior of Neoplasms (continued) c

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Uncertain behavior: tumors that cannot be determined to be either benign or malignant because some features of each are present pathologically Unspecified behavior: neither the behavior or histological type is specified in the diagnosis

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ICD-9-CM Alphabetic Index

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Main term, "Neoplasm" Table with seven columns First column for anatomical site Six columns identify behavior of neoplasm

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ICD-9-CM Alphabetic Index (continued)

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Alphabetic Index used for other types of malignancies, such as lymphatic, hematopoietic, and other neoplasms Alphabetic Index entries for specific terms Leukemia Lymphoma Multiple myeloma

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ICD-9-CM Morphology Codes

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M codes: five digits First four digits: Histological type of neoplasm Fifth digit: Behavior of neoplasm Behavior code describes type of neoplasm M codes not used for billing purposes M codes used primarily for statistical purposes

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ICD-9-CM Coding Guidelines for V Codes

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V58.0 Encounter or admission for radiotherapy V58.11 Encounter or admission for antineoplastic chemotherapy V58.12 Encounter or admission for antineoplastic immunotherapy Second code required for type of neoplasm Code from 140-208 categories

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Coding Guidelines for V Codes (continued)

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Do not use V58.0 or V58.11 as only code Need reason for therapy (diagnosis of malignancy) Do not use V10 as the only code with V58.0 or V58.11 History of cancer not reason for therapy V58.0 or V58.11, 196-198, and V10 Cancer treatment directed to secondary site with primary site identified as a history V10 code

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Coding Guidelines for V Codes (continued) b

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Admission for radiotherapy or chemotherapy with development of complications Principal diagnosis is V58.0 or V58.11 Secondary diagnosis codes for Type of neoplasm Type of complication(s)

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ICD-9-CM Coding Guidelines for V10

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Correct use of V10 category Three conditions must be true Primary malignancy previously excised or eradicated No adjunct treatment directed to that site No evidence of any remaining malignancy at the primary site

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Coding Guidelines for V10 (continued

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V10 Category intended to describe a patient who is "cured" Describes history of conditions previously coded to 140-195, 200-208, and 230-234 Not used to indicate history of a secondary malignancy site Not used when site is surgically absent but patient is still receiving cancer therapy

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ICD-9-CM Alphabetic Index

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Locate the morphology of the tumor in the Alphabetic Index Determine if code is available for specific histology type Neoplasms of lymphatic and hematopoietic tissue Malignant melanomas of skin Lipomas Common tumors of bone, uterus, and ovary

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Alphabetic Index (continued)

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2. Follow instructions under the main term in the Alphabetic Index See also Neoplasm, by site, (type of behavior) Directions in Alphabetic Index can be overridden if the documentation in the record specifies a different behavior Malignant adenoma

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ICD-9-CM Tabular List

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Code functional activity associated with a neoplasm with additional code Note variations in categories 150 and 201 Subcategories overlap and are not mutually exclusive Code according to terminology used in the health record

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ICD-9-CM Coding of the Anatomic Site - Malignant Neoplasms

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Solid tumors Primary sites 140-195 Secondary or metastatic sites 196-198 Lymphatic and hematopoietic tissue Considered systemic and do not metastasize Categories 200-208

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ICD-9-CM Primary Site

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Defined as the origin or original site of the tumor: categories of 140-195 Unknown primary site, 199.1

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ICD-9-CM Category 195 & Asterisk (*)

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Other and ill-defined sites Contiguous sites such as head and neck Anatomical site followed by asterisk (*) See note (2) after Neoplasm in Alpha Index See "skin" of stated anatomic site Squamous cell or epidermoid carcinoma should be coded as malignant neoplasm of skin Papilloma of any type should be coded as benign neoplasm of the skin

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ICD-9-CM Contiguous Sites

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Origin of primary tumor may involve two adjacent sites Neoplasms with overlapping site boundaries coded to fourth-digit subcategory 8, titled "other"

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ICD-9-CM Classification of Primary Sites

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Surgical removal followed by adjunct therapy Assign malignancy code (140-198, 200-208) as long as therapy is administered Example: Carcinoma of breast surgically excised, patient admitted for chemotherapy─Code carcinoma of breast as primary site

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Classification of Primary Sites (continued)

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Surgical removal followed by recurrence If primary malignant neoplasm was previously removed by surgery or eradicated, the primary malignant code for that site is assigned Example: Recurrence of carcinoma of lip Code as a primary site of lip Follow the Alphabetic Index directions, for example, mastectomy site Index indicates a secondary site 198.2, mastectomy site, because breast has been removed. (Pathology report should be reviewed to confirm malignant tissue was found in skin and not breast tissue.)

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Classification of Primary Sites (continued) b

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"Metastatic from" When cancer is described as "metastatic from a specific site" Code the site as primary Example Carcinoma in cervical lymph nodes metastatic from lower esophagus Primary site is esophagus Secondary site is cervical lymph nodes

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ICD-9-CM Classification of Secondary Sites

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"Metastatic to" a site and "direct extension to" The "metastatic to" site stated is a secondary site Example: Metastatic carcinoma of the colon to the lung Primary site is colon Secondary site is lung

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Classification of Secondary Sites (continued)

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"Spread to" or "extension to" Diagnoses should be coded as primary sites with metastases Example: Adenocarcinoma of the stomach with spread to the peritoneum Primary site is stomach Secondary site is peritoneum

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Classification of Secondary Sites (continued) b

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Patient may have multiple secondary sites Each site is coded Unspecified (or unknown) secondary site, 199.1 Malignancy has spread but exact location is not stated by physician

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ICD-9-CM Coding of Metastatic Disease of One Site

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Example: Metastatic ovarian carcinoma Is the site stated the primary or secondary site? Step 1. Locate the morphology type of the neoplasm in the Alphabetic Index Step 2. Review subterms for the specific site If the specific site is identified, assign the code If the specific site is not included, assign code for the primary of "unspecified" site

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Metastatic of One Site (continued)

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Step 3. If code obtained in step 2 is 199.0 or 199.1, follow directions under step 5 Step 4. Since primary site is identified, another code must be assigned for metastatic site Unknown or unspecified = 199.1

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Metastatic of One Site (continued) b

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Step 5 If morphology is not stated or if code obtained in step 2 is 199.0 or 199.1, then site described as metastatic should be coded as the primary site Exception to the rule: Certain sites must be coded as secondary sites

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Metastatic of One Site (continued) c

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Step 5 Exceptions: If the following sites are stated, each must be coded as secondary of that site: Bone Brain Diaphragm Heart Liver Lymph nodes Mediastinum Meninges Peritoneum Pleura Retroperitoneum Spinal cord Sites in category 195

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Metastatic of One Site (continued) d

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Step 6 - example Metastatic carcinoma of bronchus Morphology is carcinoma Main term "carcinoma" Subterm for unspecified type No subterm found See also Neoplasm, by site, malignant

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Metastatic of One Site (continued) e

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Step 6 Metastatic carcinoma of bronchus Table of Neoplasm, unspecified site, primary Note code 199.1 is listed for unspecified site Since code 199.1 is found and bronchus is not included in the exception list, assign bronchus as the primary site Assign code for secondary site, Table of Neoplasm, unspecified site, 199.1

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ICD-9-CM Coding of Neoplasm-Related Pain

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A code for neoplasm-related pain, 338.3, is assigned for pain documented as being related, associated, or due to a primary or secondary malignant neoplasm Pain may be acute or chronic in nature

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ICD-9-CM Coding of Neoplasm-Related Pain b

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A code for neoplasm-related pain, 338.3 May be principal or first-listed diagnosis when the reason for the inpatient admission or outpatient encounter is documented as pain control or pain management The underlying neoplasm should also be coded as an additional diagnosis

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ICD-9-CM Coding of Neoplasm-Related Pain c

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May be reported as additional diagnosis Code 338.3 for neoplasm-related pain may be coded as an additional diagnosis for an inpatient admission or outpatient encounter when the reason for the care is management of the neoplasm, and the pain associated with the neoplasm is also documented

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Other Conditions Described as Malignant

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Medical term "malignant" has two meanings Resistant to treatment, occurring in severe form and frequently fatal; tending to become worse and leading to an ingravescent (increasing in severity) course Related to a neoplasm, means having the property of locally invasive and destructive growth and metastasis

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Other Conditions Described as Malignant (continued)

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Effusion is the escape of fluid from blood vessels or lymphatics into the tissues or a cavity, such as the pleural cavity, pericardium or the peritoneum May not always contain malignant/cancer cells Malignant ascites - fluid in peritoneum (789.51) Malignant pleural effusion - fluid in the pleural cavity (511.81)

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ICD-9-CM Official Guidelines for Coding and Reporting Neoplasms

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Coding of neoplasms is a challenging task for coders Take extra time to review the Official Guidelines for coding neoplasms in Section 1, Part C, Number 2, for the chapter on neoplasms These are important rules that all coders must follow for accurate coding

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ICD-10-CM Chapter 2: Neoplasms (C00-D49)

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C00-C75: Malignant neoplasms stated or presumed to be primary and certain specified histologies, except neuroendocrine and of lymphoid, hematopoietic and related tissues C7A: Malignant neuroendocrine tumors C7B: Secondary neuroendocrine tumors

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ICD-10-CM Chapter 2: Neoplasms (C00-D49)

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C76-C80: Malignant neoplasms of ill-defined, other secondary and unspecified sites C81-C96: Malignant neoplasm of lymphoid, hematopoietic and related tissue D00-D09: In situ neoplasms D10-D36: Benign neoplasms except benign neuroendocrine tumors

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ICD-10-CM Chapter 2: Neoplasms (C00-D49) b

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D3A: Benign neuroendocrine tumors D37-D48: Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes D49: Neoplasms of unspecified behavior

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ICD-10-CM Neoplasm Table

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Organized into columns Left column = Anatomic site Next 6 columns codes for Primary malignant Secondary malignant CA in situ Benign Uncertain Unspecified

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ICD-10-CM Neoplasm Table cont

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Codes listed in the ICD-10-Cm Neoplasm Table with a dash (-) following the code have a required 5th character for laterality Tabular List must be reviewed for complete code

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ICD-10-CM Neoplasm Table cont b

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ICD-10-CM Guidelines for Neoplasm include General neoplasm guidelines Reference the Neoplasm Table first If histological term is document, that term may be referenced in Alphabetic Index first Treatment directed at the malignancy Treatment of secondary site

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ICD-10-CM Neoplasm Table cont c

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ICD-10-CM Guidelines for Neoplasm include Coding and sequencing of complications Primary malignancy previously excised Admission/encounters involving chemotherapy, immunotherapy and radiation therapy Sequencing of neoplasm codes

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ICD-10-CM Chapter 2 Tabular List Instructions

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Instructional notes included to use an additional code to identify such conditions as alcohol abuse and dependence, alcohol dependence in remission, tobacco dependence, and history of tobacco use. Other instructional notes state to use an additional code from Chapter 4 to identify functional activity associated with any neoplasm

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ICD-10-CM Morphology (Histology)

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Chapter 2 classifies neoplasms primarily by site (topography) with broad groupings for behavior (malignant, in situ, benign, and so on) For certain conditions, the morphology is included in the category code, for example, malignant melanoma and certain neuroendocrine tumors

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ICD-10-CM Primary Malignant Neoplasms with Overlapping Sites

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A primary malignant neoplasm that overlaps two or more contiguous sites should be classified to the subcategory/code ".8" unless the combination is specifically indexed elsewhere For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of same breast, codes for each site should be assigned

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