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ALL

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Acute lymphoblastic leukemia

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AML

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acute myelogenous leukemia

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BCE

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Basil cell epithelioma

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BMA

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bone marrow aspiration

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BSe

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breast self-exam

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Bx

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biopsy

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Ca, CA

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Cancer, Carcinoma

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CA-125

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ovarian carcinoma antigen (tumor marker-ovary)

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CEA

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carcinoembryonic antigen (tumor marker-colon, lung, breast, others)

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Chemo

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chemotherapy

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PSA

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prostate specific antigen (tumor marker-prostate)

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TNM

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tumor, nodes, metastasis (refers to tumor staging)

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ICD-9-CM Codes Neoplasms according to:

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the form and structure of the cell (morphology) AND anatomical site

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Neoplastic conditions are located in the Alphabetic Index by:

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refferring to the morphological term or referencing the neoplasm table

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Patients with malignant conditions may experience:

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- Anorexia - Abnormal bleeding, bruising - Difficulty swallowing - Indigestion - Malaise - Fever - Sores that will not heal or that change to the appearance of a wart or mole - Bladder and bowel habit changes - mass in breast or other body site - persistent cough - weight loss

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How do you determine if a patient has cancer present?

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Various lab tests & procedures - endoscopies - magnetic resonance imaging (MRI) - computed tomography (CT) scans - X-rays & ultrasound - biopsy

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Characterize a BENIGN NEOPLASM

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- usually grow slowly - are encapsulated (surrounded by a capsue) - do not metastasize - appear similar to tissue of origin under a microscope - do not cause death unless in vital organs d/t difficulty removing them (spinal cord or brain)

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How are Benign and Malignant neoplasms named and classified?

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By the tissue of origin; Named by adding the suffix "OMA" to the name of the body part... i.e. LIPOMA... a benign neoplasm of adipose tissue

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Malignant tumors include:

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- Carcinoma- cancer of epithelial cells of connective tissue - Lymphoma - Cancer of lymph nodes & immune sys - Leukemia - Cancer of blood-forming organs - Melanoma - Caner of melanin-producing cells - Sarcoma - Cancer of supportive tissue such as blood vessels, bones, cartilage, and muscles

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Basal Cell Carcinoma of Skin

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most common form of skin cance - forms in epidermal layer of the skin

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Types of Basal Cell Carcinoma are:

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- Sclerosing - noduloulcerative - superficial

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Most common cause of basal cell carcinoma

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Prolonged sun exposure..... Other causes: - radiation exposure - immunosuppression - arsenic ingestion

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Basal Cell Carcinoma signs / symptoms:

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- small, smooth, translucent lesions form in early stages - ulcerations & tumors spread/infected in later stages - Sclerosing basal cell looks waxy & has yellowish plaques w/o any distinct border. - superficial basal cell are found on chest/back & are irregularly shaped lesions. May appear to have a scaly look w/ atrophic areas in the center of it.

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Basal Cell Clinical Tests and Treatment:

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Clinical Test(s): - Biopsy & examination Treatment: - Excision, Chemotherapy, Radiotherapy, Cryotherapy.

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Common Benign and Malignant neoplasms

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See Table 7-1 on pg. 108.

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Coding of Neoplasms / ICD-9-CM Groups Neoplasms into behavior groups:

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ICD-9-CM Groups Neoplasms into behavior groups... 6 groups, each has a column

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Malignant Neoplasms (primary and secondary)

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Code Range 140-208

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Benign Neoplasms

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Code Range 210-229

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Cancer in situ

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Code Range 230-234

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Uncertain Behavior

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Code Range 235-238

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Unspecified Neoplasm

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Code Range 239

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How to select a Neoplasm Code:

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* Coder must reference patient's record to determine the type of neoplasm present. - A biobsy or pathology report gives the most definitive information. - Chpt. 2 "Neoplasms" of ICD-9-CM contains all of the codes for malignant conditions and most of the codes for benign conditions.

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Adenocarcinoma of the Breast

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Commonly called Breast Cancer= A malignant neoplastic condition.

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Signs/ Symptoms Breast Cancer

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- lump/mass in breast or armpit... firm/hard when palpated - Unusual drainage/discharge from nipple - change in breast or nipple size or shappe - Change in skin w/ redness or pitting or the skin - Edema of the arm

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Breast Cancer, Clinical Tests

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to confirm adenocarcinoma of the breat a BIOPSY is completed. * Several types of biopsies: - incisional - fine-needle aspiration - needle biopsy

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Breast Cancer, Treatment

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*depends on extent of breast cancer.... - Surgical intervention - chemotherapy - radiation therapy - tamoxifen and other hormonal therapies r options

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Benign neoplasms coded to specific body systems:

answer

- Polyp of nasal cavity = 471.0 / Respiratory - Cyst of oral soft tissue = 528.4 / Digestive - Ovarian Cyst = 620.2 / Genitourinary - Prostatic adenoma = 600.20-600.21 Genitourinary - Cyst of bone = 733.20-733.29 / musculosekeletal

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Carinoma in situ = ca in situ or CIS:

answer

neoplastic cells undergoing malignant changes that are confined to the original epithelium site w/o invading surrounding tissues. Common sites; bladder, breast, cervix, vulva

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Neoplasms of Uncertain Behavior 235-238

answer

include cases in which the neoplasm exhibits charac teristics of both benign and malignant behavior after pathological investigation. ***Should be assigned ONLY when Pathological report concludes behavior of neoplasm can't be confirmed & further study is needed for definitive diagnosis.

question

Neoplasms of Uncertain Behavior

answer

(235-238) classify by site certain histomorphologically well-defined neoplasms, the subsequent behavior of which cannot be prediction from the present appearance.

question

Category 239

answer

used for Neoplasms of unspecified Nature.... - cases in which behavior or morphology of neoplasm have not confirmed

question

Neoplasms of Unspecified Nature i.e.'s

answer

- Pt is transferred fr. one facility to another w/o accompanying medical info. or complete diagnostic studies not completed @ 1st facility. - Pathological workup is not completed - Pt. is outpatient & pathological study is pending - Pt. is transferred to a facility to determine definitive nature of the neoplasm

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Neoplasms of Unspecified Nature (239)

answer

* To specify this category, a NOTE: is included in the Tabular List after the category heading Neoplasms of unspecified nature (239)

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How are codes for NEOPLASMS located?

answer

In Alphabetic Index, codes for neoplasms are located by: - referencing the name of the neoplasm and using the neoplasm table. - Once anatomical site is located, the table lists codes for malignant, benign, uncertain, and unspecified behaviors.

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Neoplasm Table

answer

Organized Alphabetically by anatomical structure

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Malignant Neoplasms organized in Table by 3 columns:

answer

- Primary (origin site of neoplasm) - Secondary (site it spread to) - CA in situ (used if pathalogical record states it)

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"Metastatic FROM" = site of origin/ primary

answer

indicates the carcinoma originated there... i.e. "Metastatic carcinoma FROM the kidneys"

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"Metastatic TO" = site spread to / secondary

answer

i.e. metastatic carcinoma to the pancreas = secondary site is the pancreas

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When only ONE site is given without any further information defining the site as primary or secondary what should the coder reference?

answer

Coder should reference the medical record to determine

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When/How to assign "Unspecified or Unknown site" code:

answer

- a. 1st go to Alphabetic Index & locate type of neoplasm... follow where it instructs you to look - b. check diagnostic statement for subterms that lead to a more specific code assignment. - c. We know this is a metastasis, but dont know primary site. Because we do not have a primary site, the code assigned is 198.2 as the primary dx. - d. coder uses the "unknown / unspecified site" code on neoplasm table.... code 199.1; Malignant, primary, is the secondary code reflecting the metastasis.

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When the only code that can be used is 199.1 or if the morphology type is not given in the diagnostic explanation, the coder uses 199.1 as primary dx unless the site is one of the following:

answer

- Bone - Brain - Diaphragm - Heart - Liver - Lymph Nodes - Mediastinum - Meninges - Peritoneum - Pleura - Retroperitoneum - Spinal Cord - Sites classifiable to code 195

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Malignancy as Principal Diagnosis

answer

If treatment id directed at the nalignancy, designate the malignancy as the principasl diagnosis.

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Eradication of Malignancy and Follow-up Examinations

answer

Code selection is based on the status of the patient at the time of the encounter

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Treatment Followed by Recurrence

answer

When a pt. is treated for a malignancy... and there's evidence the cancer has recurred, the code for the primary malignancy is coded as the principal dx

question

Follow-up visit w/ No Recurrence

answer

Code category V67 is used for follow-up w/ no recurrence or metastasis. V67.09 - Follow up exam following other surgery V67.1 - Follow up exam following radiotherapy V67.2 - Follow up exam following chemotherapy V67.3 - Follow up exam following combined treatmt

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Excised Malignancy followed by Recurrence

answer

When previously excised malignancy recurs, code for malignancy is used as principal dx.

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Two primary Sites

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Used when cancer is present in 2 primary sites. Coder must determine where treatment is directed... at both sites or one. When one, it is primary dx; at both, either site can be primary dx.

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Primary & Secondary Malignancies

answer

When pt has both primary & secondary nalignancies, the coder must determine focus of treatment for proper sequencing.

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Primary Malignancy Only

answer

Designante primary malignancy as principal dx when it's only condition treated.

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Secondary Malignancy Only

answer

When tx is directed at secondary, or metastatic malignancy only, the secondary site is principal dx... unless admission is for radiotherapy or chemotherapy. An additional code is also assigned for the primary site

question

Secondary Neoplasm with Excision or Eradication of Primary Site (primary shows no more malignancy)

answer

Secondary neoplasm is Principal dx... and code from category V10 is assigned to former primary site

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Code V10

answer

Personal Hx of malignant neoplasm... in Alpha Index; used to code former primary Malignancy that was erradicated/excised.

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Contiguous Sites

answer

**physician cant determine origin of neoplasm b/c site or origin appears to be in 2 adjacent sites. In these cases a fourth digit of 8 is used to signify that there are overlapping sites.

question

Anemia in Neoplastic Disease 285.22

answer

may used as primary if only symptom for encounter,w/ malignancy as secondary; or as secondary if being treated for neoplasm in that encounter.

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Dehydration in neoplastic disease

answer

when admission/encounter is for management of dehydration due to the malignancy or the therapy or a combination or both and only the dehydration is being treated, the dehydration is sequenced first & followed by code for malignancy.

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Surgical Procedure Performed for Treatment of Malignancy

answer

When admission/enc. is for tx of a complication from a surgical procedure designate the complication as the principal or first-listed dx if treatment is directed at resolving the complication

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Pain from cancer treatment

answer

Code as primary Malignancy...

question

Admission for Surgery, Chemo, Radiation Tx

answer

Code as Primary (140-198 or 200-203) with malignancy 2ndary

question

Encounter soley for Chemo or Radiation Tx

answer

V58.0 Encounters for Radiation Tx V58.11 Encounters for antineoplastic Chemotherapy V58.12 Encounters for antineoplastic immunotherapy Use any sequence if more than one tx is applied

question

Chemo / Radiation followed by Complications

answer

Use Type of Therapy tx code (i.e. V58.0, V58.11, V58.12) followed by symptom of complication... i.e. nausea & vomitting 207.20

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Admission / Encounter to Determine Extent of Malignancy or to perform a Procedure (paracentesis, thoracentesis)

answer

Primary malignancy or appropriate metastatic site is designated as the princiapl of first-listed diagnosis for procedure to determine extent of malignancy.

question

Paracentesis

answer

surgical puncture of abdominal cavity for aspiration of fluid

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Thoracentesis

answer

Surgical procedure for aspiration of fluid in the chest wall or to determine extenet of a malignancy.

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