Basic ICD-10-CM Coding 2013 Edition

1. Basic ICD-10-CM Coding2013 Edition Chapter 5: Neoplasms (C00–D49)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • Concepts in this chapter may require extra study time • Coding of neoplasms is one of the more difficult areas of ICD-10-CM • Understanding the coding of neoplasms requires particular attention to definitions and details • At the conclusion of this chapter, what must you know about the coding of neoplasms?

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

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

5. ICD-10-CM Chapter 2: Neoplasms (C00–D49) D3A: Benign neuroendocrine tumors D37–D48: Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes D49: Neoplasms of unspecified behavior

6. ICD-10-CM Neoplasm Behavior • Neoplasm is any new or abnormal growth of body tissue • Behavior of specific neoplasms • Review definitions of • Malignant, primary • Malignant, secondary or metastatic • Carcinoma in situ

7. ICD-10-CM Neoplasm Behavior • Review definitions of • Benign • Uncertain behavior • Unspecified behavior

8. ICD-10-CM Guidelines for Chapter 2, Neoplasms • 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

9. ICD-10-CM Guidelines for Chapter 2, Neoplasms • Review ICD-10-CM Guidelines for Neoplasm highlighted as CG in the chapter • Treatment directed at the malignancy • Treatment of secondary site • Coding and Sequencing of complications

10. ICD-10-CM Guidelines for Chapter 2, Neoplasms • Review ICD-10-CM Guidelines for Neoplasm highlighted as “CG” in the chapter (continued) • Primary malignancy previously excised • Admission/encounters involving chemotherapy, immunotherapy and radiation therapy • Admission/encounter to determine extent of malignancy

11. ICD-10-CM Guidelines for Chapter 2, Neoplasms • Symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasm • Admission/encounter for pain control management • Malignancy in two or more contiguous sites

12. ICD-10-CM Guidelines for Chapter 2, Neoplasms • Disseminated malignant neoplasm, unspecified • Malignant neoplasm without specification of site • Sequencing of neoplasm codes • Current malignancy versus personal history of malignancy

13. ICD-10-CM Neoplasm Table • Organized into seven columns • First or Left column = Anatomic site for the neoplasm • Next 6 columns codes for • Primary malignant • Secondary malignant • Carcinoma (CA) in situ • Benign • Uncertain • Unspecified

14. ICD-10-CM Neoplasm Table • Topography • ICD-10-CM classifies neoplasms by topography • Topography is a description of a region or a specific part of the body

15. ICD-10-CM Neoplasm Table • Histology • ICD-10-CM Neoplasm Table does not include neoplasms by histology • Histology is the study of the cell structures under the microscope • Certain neoplasms are identified by the histologic name of the cell structures, for example, oat cell carcinoma of the lung

16. ICD-10-CM Neoplasm Table • Histology • For certain neoplasm such as for malignant melanoma and certain neuroendocrine tumors, the histology is included in the category and codes

17. ICD-10-CM Neoplasm Table • Morphology • Morphology is the term used to describe the neoplasm in its form and structure but is not included in the neoplasm table • The description of the neoplasm will usually indicate which of the six columns is appropriate for coding, such as basal cell carcinoma or benign fibroadenoma

18. ICD-10-CM Neoplasm Table • When the name of the neoplasm does not readily identify the behavior of the neoplasm as malignant or benign, the coder should use the remainder of the Index to identify which column to use on the Neoplasm Table to assign the code.

19. ICD-10-CM Neoplasm Table • For example: Giant cell glioblastoma of brain • Is that a malignant or benign condition? • Coder should use the Alphabetic Index and locate the term “Glioblastoma” • Glioblastoma, giant cell, specified site (brain)—see Neoplasm, malignant, by site (brain) • Next step is to use the Neoplasm table under the anatomic site, brain, malignant, primary, and use the code for that entry

20. ICD-10-CM Neoplasm Table • Laterality is included in ICD-10-CM for neoplasms • Codes listed in the Neoplasm Table with a dash (-) following the code have a required fifth character for laterality, that is, right or left side • The Tabular List must be reviewed for the complete code

21. ICD-10-CM Chapter 2 Index Instructions for Classifying Neoplasms • If the morphology is stated, the coder must locate the morphology of the tumor in the Index to Diseases and Injuries. • For example, entries exist of lipoma, melanoma, sarcoma and specific codes for these types of neoplasms are included in the Index and the coder does not need to reference the Neoplasm at all

22. ICD-10-CM Chapter 2 Index Instructions for Classifying Neoplasms • If the morphology is stated, the coder must locate the morphology of the tumor in the Index to Diseases and Injuries. However, not every entry in the Index will include codes. • For example, if the doctor writes “subependymal glioma of the brain,” the Index entry of glioma, suependymal, specified site (brain) states see Neoplasm, uncertain behavior, by site (brain)

23. ICD-10-CM Chapter 2 Index Instructions for Classifying Neoplasms 3. If the morphology is stated but the physician does not include an anatomic site, the coder should locate the morphology of the tumor in the Index to Diseases and Injuries • Certain types of morphology indicate the anatomic site as the only possible site where the tumor will develop • The physician would consider writing both the morphology and the site as redundant terminology

24. ICD-10-CM Chapter 2 Index Instructions for Classifying Neoplasms 3. For example, the physician documents “serous papillary carcinoma” but the site is not stated. • The Index entry of carcinoma, papillary, serous or carcinoma, serous, papillary will give the codes an entry for “unspecified site” with code C56.9. The coder can trust this entry because serous papillary carcinoma will only occur in an ovary, which is code C56.9

25. ICD-10-CM Chapter 2 Index Instructions for Classifying Neoplasms 4. If the coder is certain about the behavior of the neoplasm, for example, carcinoma is always a malignant primary tumor, the coder should reference the ICD-10-CM Neoplasm Table as the first step. The site of the neoplasm is located and the code is selected based on the behavior of the neoplasm from the appropriate column.

26. ICD-10-CM Chapter 2 Tabular List Instructions • 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

27. ICD-10-CM Coding of the Anatomical Site • Classification of Malignant Neoplasms • Malignant neoplasms are separated into primary sites and secondary or metastatic sites with further subdivisions by anatomic sites • Neoplasms of lymphatic and hematopoietic system are always coded to categories C81–C96. These are leukemias and lymphomas, systemic conditions, and as such do not metastasize, so it would not be coded to a secondary malignant neoplasm.

28. ICD-10-CM Coding of the Anatomical Site • Classification of Malignant Neoplasms • Neuroendocrine tumors include both malignant and benign tumors that arise from certain cells scattered throughout the body. • Neuroendocrine are either carcinoid tumors or pancreatic endocrine tumors • Many of these tumors are associated with the multiple endocrine neoplasia syndrome or carcinoi syndrome that is coded separately

29. ICD-10-CM Coding of the Anatomical Site • Determination of the Primary Site • Primary site is the site where the tumor originated • Usually identified by the physician in the diagnosis • However, it is possible that the primary site cannot be determined by the physician • Neoplasm Table has an entry for this situation with first column entry of “unknown site or unspecified” and there is a code for unknown primary or secondary sites

30. ICD-10-CM Coding of the Anatomical Site • Determination of the Primary Site • Category C76 is a code for malignant neoplasms of other and ill-defined sites, is available for use only when a more specific site cannot be identified. • This category is used only when a more specific site cannot be identified • It is also used for malignant neoplasms of contiguous sites when the point of origin cannot be determined

31. ICD-10-CM Coding of the Anatomical Site • Determination of the Primary Site • Primary Malignant Neoplasms Overlapping Lesion • A tumor may develop at the junction of two parts of an organ or two organs next to each other • When the neoplasm is identified as overlapping it will be classified to the subcategory code .8

32. ICD-10-CM Coding of the Anatomical Site • Classification of Secondary Sites • A secondary site may be referred to as a metastatic • Terms such as Metastatic to or Direct Extension to are identifying a specific site that is the secondary site of the neoplasm or where the cancer spread to • Metastatic carcinoma of the colon to the lung • The colon is the primary site • The lung is the secondary site

33. ICD-10-CM Coding of the Anatomical Site • Classification of Secondary Sites • Terms such as Spread to and Extension to identify primary sites with metastases • Adenocarcinoma of the stomach with spread to the peritoneum • The stomach is the primary site • The peritoneum is the secondary site

34. Malignant Neoplasm of Lymphatic and Hematopoietic Tissue • These conditions include lymphomas that arise out of lymph tissue, multiple myeloma that originates in bone marrow, and leukemia that forms in the blood with proliferation of abnormal leukocytes • These conditions are systemic and not isolated to a particular location and the concept of metastatic coding does not apply to these neoplasms

35. Malignant Neoplasm of Lymphatic and Hematopoietic Tissue • Lymphomas are classified according to their type and the specific lymph notes involved when the diagnosis was made • Multiple myeloma is classified as to whether it is stated to be in remission, in relapse, or not having achieved remission • Leukemias are classified according to their type, such as lymphoid, myeloid or monocytic and how the condition currently exists (in remission, in relapse or not)

36. Neoplasm-Related Pain • Patient with a malignancy may seek medical care because of neoplasm-related pain. • Code G89.3, neoplasm-related pain (acute)(chronic) is assigned to pain documented as being related to, associated, or due to a primary or secondary malignant neoplasm

37. Neoplasm-Related Pain • Code may be principal or first-listed when the stated reason for the admission or outpatient encounter is for pain control or pain management. The underlying neoplasm is reported with it as an additional diagnosis. • When the reason for the admission/encounter is the management of the neoplasm and the pain associated with it is also documented, the code for the neoplasm-related pain is assigned as an additional diagnosis. The underlying neoplasm is listed first.

38. Other Conditions Described as Malignant • Meaning of the term malignant • Malignant means resistant to treatment, occurring in severe form and frequently fatal, tending to become worse and leading to an ingravescent course. • Malignant in reference to a neoplasm it means the tumor has the property of locally invasive and destructive growth and metastasis

39. Other Conditions Described as Malignant • Meaning of the term malignant • Effusion is the escape of fluid from blood vessels or lymphatics into the tissues or a cavity • Fluid may accumulate in the pleural cavity, pericardium or particularly in the peritoneum called ascites • Codes for malignant ascites or malignant pleural effusion have a code first the malignancy

40. ICD-10-PCS Coding for Procedures Related to Neoplasms • Neoplasms are often treated with removal of tumors via surgical procedures • The three root operations that take out some or all of a body part to remove a tumor are “excision,” “resection,” or “destruction” • If a biopsy of a tumor was performed, the root operation of excision would be used with the qualifier value of X used to identify it as a diagnostic procedure.

41. ICD-10-PCS Coding for Procedures Related to Neoplasms • Neoplasms are often treated with removal of tumors via surgical procedures • The root operation of excision would be used when a part of the body part is excised • The root operation of resection would be used when all of a body part is removed • The root operation of destruction is defined as the physical eradication of all or a portion of a body part

42. ICD-10-PCS Coding for Procedures Related to Neoplasms • Antineoplastic chemotherapy is an infusion procedure coded with a procedure from the administration section of ICD-10-PCS

43. ICD-10-PCS Coding for Procedures Related to Neoplasms • The root operation “Introduction” is used to code chemotherapy with the main term in the Alphabetic Index of “introduction of substance in or on” • The subterm identifies where the infusion is introduced—vein, central or peripheral • The approach is usually percutaneous • The sixth character is the substance infused with the value 0 for antineoplastic • The seventh character for qualifier identifies the chemical infused as other antineoplastic or monoclonal antibody

44. Exercises • Practice coding the diagnoses of certain infectious and parasitic diseases and the related procedures using the review exercises for Chapter 5