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direct extension

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The invasion of adjacent sites by a malignant neoplasm

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invasive

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The extension of tumor cells to other adjacent sites

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metastasis

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The resulting spread of invasive tumor cells

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neoplasm

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C00 - D49 ...A new or abnormal growth Note - certain benign neoplasms may be found in specific body system chapters

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morphology codes

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...are optional but are used in tumor Registries and pathology indexes

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Neoplasm Behavior classification

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First axis: Behavior Second axis: Anatomical site

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Neoplasm Behavior groups

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C00 - C75, C76 - C96 = Malignant C7A C7B, D3A = Neuroendocrine (aka Merkel Cell Carcinoma) D00 - D09 = Carcinoma in situ D10 - D36 = Benign D37 - D48 = Uncertain Behavior D49 = Unspecified Behavior

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in situ

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Undergoing malignant changes but are still confined to the point of origin without invasion of the surrounding normal tissue

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Intraepithelial

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...

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Non infiltrating

answer

...

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Non-invasive

answer

...

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Pre invasive

answer

...

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Index - see disease

answer

The index direct you to "see Disease" by sight for Legion, organ or site NEC

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Morphology classification

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Refers to the form and structure of tumor cells and his study in order to classify a neoplasm by its tissue of origin

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Locating codes for neoplastic disease

answer

Step 1 - refer to the main term for the morphological type in the alphabetic index of diseases and injuries- review the subentries Note - when the site is not listed as a sub term for when a specific code is not given in the alphabetic index a cross reference to the neoplasm table in volume 2 of the index appears Note - to use the neoplasm table coders must first locate the anatomical site in the list it, move across the page to the behavior type, then select the appropriate code

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Two basic types of malignant neoplasms

answer

Solid Hematopoietic and lymphatic

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Overlapping sites

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When a primary malignant neoplasm overlaps two or more contiguous sites it is classified to the sub category / code ".8" signifying "overlapping lesion" - unless the combination is specifically indexed elsewhere

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Malignancy in two or more non-contiguous sites

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Note when the documentation is unclear the provider should be queried regarding the status of each tumor in order to select the correct codes

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Synchronous primary cancers

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When more than one primary cancer occurs in the same organ system

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Metastatic vs. Metastasis

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Often used Ambiguously in describing a neoplastic disease sometimes meaning that the site named is primary and sometimes meaning that the site is secondary Note - when diagnostic statement is not clear in this regard the coder should review the medical record for further information - when none is available see following guidelines Metastatic to Metastatic from Multiple metastatic sites Single metastatic site No site stated

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Metastatic to

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Indicates that the site mentioned is secondary

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Metastatic from

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Indicates that the site mentioned is primary

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Multiple metastatic sites

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When two or more sides are described as metastatic in the diagnostic statement each of the metastatic sites should be coded as secondary or metastatic

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Single metastatic site

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When only one side is described as metastatic without any further qualification and no more definitive information can be obtained by reviewing the medical record the following steps should be followed - refer first to the morphology type in the alphabetic index and code to the primary condition of that site - when the morphology type is not stated or the only code that can be obtained is either C80.0 or C80.1 who does primary malignant neoplasm unless the site is one of the following: bone, brain coma diaphragm, heart, liver, 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 except for neoplasm of the liver: C22.9.

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No site stated

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This code should only be used when no determination can be made as to the primary site of a malignancy ...when no site is indicated in the diagnostic statement but the morphology type is qualified as metastatic the code provided for that morphological type is assigned for the primary diagnosis along with an add code for secondary neoplasm of unspecified site

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Neoplasms of lymph nodes or glands

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C81 - C88

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Hodgkin's lymphoma

answer

C81 Type of cancer originating from lymphocytes - characterized by giant Reed Sternberg cells

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Non-Hodgkin's lymphomas

answer

A heterogeneous group of malignant lymphoma a clinical picture that is similar to Hodgkin's disease with the absence of the giant reed-sternberg cells that are characteristic of Hodgkin's lymphoma

question

Categories for non-hodgkin lymphomas

answer

C82, Follicular lymphoma C83, Non follicular lymphoma C84, Mature T / NK cell lymphoma C85, Other and unspecified types of Non-Hodgkin's lymphoma C86, Other specified types of T / NK cell lymphoma C88, Malignant immunoproliferative diseases and certain other B-cell lymphomas

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Multiple myeloma, other immuno proliferative neoplasms, and leukemias

answer

5th char for all codes C90 - C95: 0 - Not having achieved remission failed remission 1 - In remission 2 - In relapse

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Sequencing of codes for neoplastic diseases

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Principal diagnosis is the condition found after study to have occasioned the current encounter

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Treatment directed at primary site

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When treatment is directed toward the primary site of malignancy of that site is designated as the principal diagnosis in which case the primary malignancy is coded as the principal diagnosis followed by any metastatic sites

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Treatment directed at primary site / 2 primary sites

answer

Sometimes two primary sites are present - in this case each is coded as a primary neoplasm - when treatment is directed primarily toward one side the neoplasm of that site should be designated as the principal diagnosis - when treatment as directed equally toward both either may be designated as the principal diagnosis

question

Treatment directed at secondary site

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A patient is admitted because of a primary neoplasm with metastasis and treatment is directed solely toward the secondary site a secondary site is designated as the principal diagnosis even though the primary malignancy is still present Note - a code for the primary malignancy is assigned as an additional diagnosis

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Admission for complications associated with malignant neoplasm

answer

When admission is primarily for treatment of the complication the complication is coded first death followed by the appropriate code or codes for the neoplasm Note - an exception to this guideline is anemia

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Encounter for management of anemia associated with malignancy - treatment for anemia

answer

The appropriate code for malignancy a sequence as a principal diagnosis - followed by code D63.0, anemia in neoplastic disease

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Encounter for management of anemia associated with radiotherapy

answer

Anemia code should be sequenced first + Appropriate neoplasm code + Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient or of later complication without mention of misadventure at the time of the procedure

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Encounter for management of anemia documented as "pancytopenia due to chemotherapy"

answer

D61.810

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Encounter for management of dehydration due to malignancy or therapy or both - dehydration is being treated

answer

Dehydration is sequence to First + Codes for malignancy

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Encounter for treatment of complications resulting from surgical procedure

answer

Complication listed as principal diagnosis if treatment is directed at resolving the complication

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Surgical removal of neoplasm primary or secondary site

answer

... followed by adjunct chemotherapy or radiation treatment during the same episode of care The code for the neoplasm should be assigned as principal diagnosis

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Encounter solely for administration of chemotherapy, immunotherapy, or radiation therapy

answer

Principal diagnosis... Z51.0, Encounter for antineoplastic radiation therapy Z51.11, Encounter for antineoplastic chemotherapy Z51.12, Encounter for antineoplastic immunotherapy Note - when the patient receives more than one of these therapies during the same encounter more than one of these codes may be assigned in any sequence Note - because the patient is still under treatment for malignancy even though it may have been removed surgically... Add code - for malignancy rather than a code from category Z85

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Encounter for purpose of radiotherapy, immunotherapy, or chemotherapy - developed complications

answer

First listed code - encounter for therapy Add code - for any complications

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Tumor lysis syndrome TLS

answer

A group of serious potentially life-threatening metabolic disturbances that can occur after antineoplastic therapy or as a result of radiation or corticosteroid therapy

question

Encounter for purpose of inserting port for later administration of chemotherapy

answer

... no chemotherapy is given during same episode of care - malignancy is designated as principal diagnosis ... When insertion of Port is followed by chemotherapy during same episode of care assign Dash Z51.11, Encounter for antineoplastic chemotherapy

question

Encounter for intraperitoneal catheter for chemotherapy

answer

... Chemotherapy is administered during episode of care assign - 3E0M305, Introduction of other antineoplastic into peritoneal cavity percutaneous approach

question

Admission for radium implant insertion for treatment by radioactive iodine

answer

I-131 ... is not considered an admission solely for radiotherapy session Note - the code for the malignant neoplasm is designated the principal diagnosis - Z51.0 is not assigned

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Encounter to determine extent of malignancy

answer

The primary malignancy or appropriate metastatic site is designated as principal diagnosis - even though chemotherapy or radiotherapy is administered

question

Current malignancy vs. Personal history of malignancy

answer

When primary malignancy has been excised for further treatment - the primary malignancy code should be used until treatment is completed The g code for personal history of malignant neoplasm are signed only when the primary neoplasm has been previously excised or totally eradicated from its side and is no longer under any type of treatment and there is no evidence of any existing primary malignancy

question

Malignant neoplasm associated with transplanted organ

answer

Malignant neoplasm of a transplanted organ should be coded as a transplant complication Code 1st - from category T86.- as principal diagnosis Code 2nd - C80.2, malignant neoplasm associated with transplanted organ Add code - any code assigned for specific malignancy

question

Malignant neoplasm in a pregnant patient

answer

Codes from chapter 15 of ICD pregnancy childbirth and the puerperium are always sequence first on a medical record O9A.1-, malignant neoplasm complicating pregnancy, childbirth, and the puerperium Add code - appropriate code to indicate type of neoplasm from chapter 2

question

Pathologic fracture due to a neoplasm

answer

The sequencing of pathological fractures due to neoplasm is dependent on the focus of treatment - ...Code 1st: if the focus of treatment is the fracture - a code from subcategory M84.5, pathological fracture in neoplastic disease Add code - code for the neoplasm ...Code 1st: if the focus of treatment is the neoplasm with an Associated pathological fracture - the neoplasm code should be sequenced first Code 2nd: from category M84.5 Note - "code also" note at M84.5 provides this sequencing instruction

question

Malignant ascites

answer

R18.0 The abnormal buildup of fluid in the abdomen caused by malignancy

question

Malignant pleural effusion

answer

J91.0 Can occur due to impaired pleural lymphatic drainage from a mediastinal tumor

question

Encounter for prophylactic organ removal

answer

Encounter specifically for prophylactic removal of breast ovaries, or other organ due to a genetic susceptibility to cancer or a family history of cancer Dash Code first: Z40, encounter for prophylactic surgery Add diagnosis: appropriate code to identify the associated risk factor Note - if patient has malignancy of one side and is having prophylactic removal of another site to prevent new malignancy in that site a code for the malignancy should also be assigned as ADD code

question

Coding of admissions or encounters for follow-up examination

answer

Z codes cover most and counters once malignant neoplasm has been excised or eradicated for follow-up examination When there is evidence of recurrence at primary site code for malignancy is designated as principal diagnosis When there is no recurrence of primary site but there is evidence of metastasis to a secondary site a code for secondary neoplasm of that site is a signed along with the code from category Z85

question

Treatment of neoplasms

answer

Char 1: Medical and Surgical Root Op: Excision, Resection, Destruction, and Extirpation

question

Lymph node Excision / resection

answer

Char 1: Medical and Surgical Root Op: Excision or Resection

question

Thermal ablation

answer

Char 1: Medical and Surgical Root Op: Destruction

question

Chemotherapy and immunotherapy

answer

Char 1: Administration Root Op: Introduction

question

Radiation therapy

answer

Char 1: Radiation Therapy Char 2: Body System Char 3: (Root Op) Modality (best manner of treatment) Char 4: Treatment Site Char 5: Modality Qualifier Char 6: Isotope Char 7: Qualifier

question

Modalities used in Radiation Therapy

answer

Beam radiation Brachytherapy Stereotactic radiosurgery Other radiation

question

Laser interstitial thermal therapy

answer

Char 1: Radiation Therapy Root Op: Other radiation

question

Intraoperative electron radiation therapy

answer

Char 1: Radiation Therapy Root Op: Beam radiation

ICD-10-PCS Coding Handbook Chap. 29 – Flashcards

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