Neoplasms

Chapter II

HS317b - Coding & Classification of Health

Information

Neoplasm

Can occur in all body systems Can be classified by anatomical site,

behaviour and morphology. To code neoplasms think in terms of the

disease process

Coding Rules for Neoplasms

MRDx is based on what site they are treating (primary or secondary)

Apply specificity standard Assign separate codes for each primary

and secondary Morphology coding is optional C80 Malignant neoplasm without

specification if documentation is vague

Primary Neoplasm

Code to point of originThis includes when cancer invades into

adjacent tissue and is still connected to original site

Be as specific as documentation allows Code to site

Example: Ca of the small intestine C17 Malignant neoplasm of small intestine

Duodenum (C17.0)Jejunum (C17.1) Ileum (C17.2)Meckel’s diverticulum (C17.3)

Overlapping Boundaries (contiguous sites) Within a 3-digit category & point of origin is

underdetermined Example:

C17.8 Overlapping malignant lesion of small intestine

Overlapping sites within certain systems Overlaps the boundaries of three-

character categories within certain systems. See note at beginning of neoplasm chapter

E.g. Ca of stomach (C16.~) and small intestine (C17.~)C26.8 Overlapping lesion of digestive system

Overlapping systems C02.8 Overlapping lesion of tongue C08.8 Overlapping lesion of major salivary glands C14.8 Overlapping lesion of lip, oral cavity and pharynx C21.8 Overlapping lesion of rectum, anus and anal canal C24.8 Overlapping lesion of biliary tract, C26.8 Overlapping lesion of digestive system C39.8 Overlapping lesion of respiratory and intrathoracic organs C41.8 Overlapping lesion of bone and articular cartilage C49.8 Overlapping lesion of connective and soft tissue C57.8 Overlapping lesion of female genital organs C63.8 Overlapping lesion of male genital organs C68.8 Overlapping lesion of urinary organs C72.8 Overlapping lesion of central nervous system

Metastatic Neoplasms

When solid malignant neoplasms spread to other sites through local invasion of adjacent sites, metastasis to distant sites or seed.

ICD-10 does not make a distinction between method of metastasis.

This excludes local invasion into tissue within a body system (Code to point of origin).

Other terminology—secondary neoplasm

Lymphomas and Leukemia

These neoplasms do not metastasize to secondary sites. They circulate within the lymphatic or hematopoetic circulation and may occur in other sites within these tissues.

Assigned to morphology rather than site.

Admissions following diagnosis of CA

Patient admitted for definitive surgery to remove tissue from site of previous biopsy & pathology report is negative for malignancy.MRDx is primary neoplasm i.e.: Ca of breast. For diagnosing purposes a

needle biopsy of lump shows CA. Patient admitted for lumpectomy & pathology was negative for malignancy

Follow up admissions

Various scenarios can be encountered to allow one to code history or follow up codesRecurrent malignancies Interventions after diagnosis of Ca madeObservation for suspected malignancyHistory of malignant neoplasmsChemotherapy/Radiation Prophylactic interventions

Recurrent Malignancies

Example Ca of right breast—lumpectomy removed entire lesion A year later returns with lesion at site of previous lumpectomy.

According to documentation this is a recurrence of the primary malignancy.

Ca previously eradicated but recurrent in the same organ or tissue Code as primary (unless documentation directs you differently) Include code for history of malignancy C50.90 Ca R breast + Z85.3 Personal history of malignant

neoplasm of breast

Observation for suspected CA

When a patient presents with symptoms but tests prove negative for malignancyMalignancy is ruled outNo further treatment is necessary

Code:

Z03.1 Observation for suspected malignant neoplasm

History of Malignant Neoplasms

Different scenariosPersonal history of malignancyFollow up examinations after initial

interventionFamily history of malignancy

Personal History – Z85.~ Never to be used as MRDx Always assign diagnosis type 3 Only assign for primary malignancies

When Ca has been completely eradicated/excised

No further treatment directed toward primary No evidence of any remaining Ca at primary

siteThere is a recurrence at same site that was

previously excised

Follow up Examination

When no disease is found Through follow up investigation No treatment indicated

MRDx: Z08.~ Follow-up examination after treatment for malignant neoplasm

Diagnosis type 3: Z85.~ Personal history of Ca

Family History of Ca

Z80.~ Family history of malignant neoplasm

Never used as MRDx Assign diagnosis type 3

Denotes reason for prophylactic organ removal

Prophylactic Organ Removal

There is a family history of malignancyZ80.~ Family history of malignant neoplasm

Tests like PSA (Prostate Specific Antigen) or CA 125 (Cancer Antigen) positive

No disease is present MRDx: Z40.~~ Prophylactic organ

removal

Complications of Malignancy

If complications are the cause of admissionComplication is MRDxMalignancy is coded & assigned diagnosis type 3Common complications

Bacterial sepsis Chemotherapy induced neutropenia Febrile neutropenia Dehydration Hypercalcemia

Neutropenia

An abnormally low level of neutrophils in the blood.

Neutrophils are white blood cells produced in the bone marrow that ingest bacteria.

Neutropenia

It is sometimes called agranulocytosis or granulocytopenia.

It is a serious disorder because it makes the body vulnerable to bacterial & fungal infections.

Neutropenia may result from three

processesDecreased WBC productionDestruction of WBCsSequestration and margination of WBCs

Recovery from acute neutropenia depends

on the severity of the patient infection & the promptness of treatment.

When both neutropenia & fever are documented in the chart, code both D70.0 Neutropenia & R50.9 Fever, unspecified.

Dagger †/Asterisk * Standard

Dual Combination for circumstances when there are two codes for diagnostic statements containing information about both an underlying generalized disease and a manifestation in a particular organ or site which is a clinical problem in its own right. † code marks the primary code for the

underlying disease* code marks the manifestation code.

Dagger †/Asterisk *

Dagger † may be MRDx, diagnosis type 1, 2 or 3.

Asterisk * is always diagnosis type 3 and may never be used alone. “in”, “due to” or “with”

Anaemia in neoplastic diseaseD63.0* Anaemia in neoplastic disease

(C00-D48†)

Folio Lookup

Cancer - see also Neoplasm, malignant (8000/3)

8000/3 = Morphology Classification

Describes the cell of origin (histological type) Describes the behaviour of the neoplasm Optional to use Always Diagnosis type 4 When morphology diagnosis contains two

qualifying adjectives, the higher # should be used

Five digits

First four # identify histological type of neoplasm 8000 Neoplasm8140 Adenocarcinoma NOS8140 Adenocarcinoma,

metastatic NOS

/Fifth # indicates behaviour

/0 Benign /1 Uncertain whether benign or malignant /2 Carcinoma in situ /3 Malignant, primary site /6 Malignant, metastatic site /9 Malignant, uncertain whether primary or

metastatic

Review of Coding Neoplasms

Code to point of origin Has the malignancy been either excised or

eradicated? Is no further treatment being directed to the

primary site? Is there no further evidence of remaining

malignancy at the primary site. Account for primary with either malignant code or

‘history of’ code

Interventions

Therapeutic Destruction, excisional partial, excisional total,

excisional radical or excision with reconstruction

Diagnostic Inspections (endoscopy) biopsies

Chemotherapy

MRDx is Z51.1 Chemotherapy session for neoplasm

Neoplasms (active & historical malignancies) may be coded as diagnosis type 3

Intervention: 1.ZZ.35.~ ~ (identify specific drug) for systemic or total chemotherapy

Radiation

MRDx is Z51.0 Radiotherapy sessionNeoplasm (active & historical malignancies)

may be coded as diagnosis type 3) Intervention 1.~ ~. 27. ~ ~ Radiation therapy

includes anatomical site & type of radiation.

Brachytherapy

MRDx is malignancy Intervention is 1.QT. 26. ~ ~ (implant of

radioactive material)

Classification of Neoplasm MRDx

MCC 17 Lymphoma, Leukemia or unspecified site neoplasms

MCC 17A Lymphoma or leukemiaBone marrow transplant will be assigned to

CMG 700 Bone Marrow TransplantCMG 725 Major Leukemia and Lymphoma

Procedures Open biopsies, Ventricular shunts, Excisions

Classification of Neoplasm MRDx

MCC 17B Neoplasms of unspecified siteMedical partition – Radiation CMG 735,

Chemotherapy CMG 736 Similar surgical procedures as MCC17A