Chapter 2 Quiz Answers and Rationales - Neoplasms:

Question 1: According to the ICD-10-CM Neoplasm Table, there are 6 classifications to choose from regarding neoplasm behavior. Select any that apply below.

Correct answers: Benign, Uncertain Behavior, Unknown Behavior, Carcinoma in Situ, Malignant Primary, Malignant Secondary

Rationale: Reference the Neoplasm Table 

Question 2: Carcinoma of right lung

Correct answer: C34.91

Rationale: Carcinoma (malignant) > See also Neoplasm, by site, Malignant. See Neoplasm Table: Neoplasm > Lung, use the Malignant Primary Column > C34.9- (Reference tabular for last digit)

Question 3: Metastatic carcinoma of left lung (unknown primary site). Select any that apply.

Correct answers: C78.02, C80.1

Rationale:  

A.   Alphabetic Index: Carcinoma > metastatic > See Neoplasm, secondary, by site

Neoplasm Table: Neoplasm, Lung, C78.0- (Check tabular for final digit)

B.   Neoplasm Table: Neoplasm, neoplastic (no site identified) > Primary Malignancy > C80.1 

Question 4: Renal cell carcinoma

Correct answer: C64.9

Rationale:

Alphabetic Index: Carcinoma > Renal Cell > C64- (Check tabular for final digit)

Question 5: Cerebellar Sarcoma

Correct answer: C71.6

Rationale:

Alphabetic Index: Sarcoma > Cerebellar > C71.6 (Confirm in tabular)                             

Question 6: Meningeal Sarcoma of Spinal Cord

Correct answer: C70.1

Rationale:

Alphabetic Index: Sarcoma > Meningeal > See Neoplasm, Meninges, Malignant       

Neoplasm Table: Meninges, Spinal (cord) > Primary Malignancy > C70.1 (Confirm in tabular)

Question 7: Bronchial adenoma

Correct answer: D38.1

Rationale:

Alphabetic Index: Adenoma > Bronchial > D38.1 (Confirm in tabular)

Question 8: Hairy cell leukemia in remission

Correct answer: C91.41

Rationale:

Alphabetic Index: Leukemia > Hairy Cell > C91.4- (Check tabular for final digit)

Question 9: When is it appropriate to use history of malignancy from category Z85?

Correct answer: When it has been excised, there is no evidence of any existing primary malignancy, and there is no further treatment directed to the site

Rationale: According to ICD-10-CM Chapter 2 Guidelines: When a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing primary malignancy at that site, a code from category Z85 Personal history of malignant neoplasm is used to indicate the former site of the malignancy.

Question 10: According to ICD-10-CM guidelines, when a patient is admitted for for management of anemia due to malignancy, how is it reported?

Correct answer: The malignancy is reported first, followed by the code for the anemia.

Rationale: According to ICD-10-CM Chapter 2 Guidelines: When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).

Question 11: What diagnosis code is reported for secondary neoplasm of the descending colon?

Correct answer: C78.5

Rationale: Refer to the Table of Neoplasms. Look for Neoplasm > Colon (Refers you to “see also” Neoplasm, Intestine, Large. Look for Neoplasm > Intestine > Large > Colon > Descending. Use the code from the Malignant Secondary Column, guiding you to code C78.5. Verify code selection in the Tabular List.

Question 12: A patient is admitted to remove a mass from her chest. The surgeon sends it to pathology. The pathology report indicates the mass is a benign tumor and the provider documents "benign tumor" in the discharge summary. What ICD-10-CM code is reported as the principal diagnosis?

Correct answer: D36.7

Rationale: The final diagnosis is benign tumor of chest. In the ICD-10-CM Alphabetic Index, locate Tumor > Benign (Refers you to “See Neoplasm, Benign, by Site.” In the Table of Neoplasms, look for Chest (wall) NEC and report the code from the Benign Column: D36.7. Verify code selection in the Tabular List.

Question 13: A patient is admitted to for surgical removal of a lipoma located on his back involving subcutaneous tissue. What ICD-10-CM code is reported as the principal diagnosis?

Correct answer: D17.1

Rationale: In the ICD-10-CM Alphabetic Index, look for Lipoma > Site classification > Trunk (skin) (subcutaneous) D17.1. Verify code selection in the Tabular List.

Question 14: A patient is admitted with blood in her stool. She has a colonoscopy with biopsy, the results come back and the provider documents that the patient has a malignant neoplasm in her sigmoid colon. She then has surgery to remove the tumor. What ICD-10-CM code is the principal diagnosis?

Correct answer: C18.7

Rationale: According to the ICD-10-CM guidelines, when a definitive diagnosis is known, the related symptoms are not coded. In this case, only the malignant neoplasm of the sigmoid colon is reported and is the principal diagnosis. 

Look for Neoplasm > Colon (Refers you to “see also” Neoplasm, Intestine, Large. Look for Neoplasm > Intestine > Large > Colon > Sigmoid (flexure). Use the code from the Malignant Primary Column, guiding you to code C18.7. Verify code selection in the Tabular List. 

Question 15: A patient is admitted to the hospital to begin her chemotherapy. She has metastatic (secondary) liver cancer with the primary site documented as unknown. She is observed for any adverse reactions and discharged to home after 3 days. What 3 ICD-10-CM codes are reported?

Correct answers: C80.1, C78.7, Z51.11

Rationale: ICD-10-CM guideline I.C.2.e.2 indicates an encounter for chemotherapy code is to be reported as the first listed or principal diagnosis with a code for the cancer as secondary when the reason for the visit is chiefly for chemotherapy.

Look in the ICD-10-CM Alphabetic Index for Chemotherapy (session) (for)/cancer Z51.11.

For the malignancies: Look in the ICD-10-CM Table of Neoplasms for liver > Use the code from the Malignant Secondary Column, which directs the coder to C78.7. Verify code selection in the Tabular List.

In addition, Neoplasm Table: Neoplasm, neoplastic (no site identified) > Primary Malignancy > C80.1 for the unknown primary site that is documented.

Question 16: A patient is admitted to the hospital to begin her chemotherapy. She has metastatic (secondary) liver cancer with the primary site documented as unknown. She is observed for any adverse reactions and discharged to home after 3 days. What is the principal diagnosis?

Correct answer: Z51.11

Rationale: ICD-10-CM guideline I.C.2.e.2 indicates an encounter for chemotherapy code is to be reported as the first listed or principal diagnosis with a code for the cancer as secondary when the reason for the visit is chiefly for chemotherapy.

Look in the ICD-10-CM Alphabetic Index for Chemotherapy (session) (for)/cancer Z51.11.

Question 17: A patient with metastatic bone cancer (primary site unknown) is admitted for severe dehydration due to her malignancy. The patient is admitted to the hospital for intravenous hydration. What 3 ICD-10-CM codes are reported?

Correct answers: E86.0, C79.51, C80.1

Rationale: Per ICD-10-CM guideline I.C.2.c.3, when the admission/encounter is for management of dehydration due to the malignancy, and only the dehydration is being treated (intravenous hydration), the dehydration is sequenced first, followed by the code(s) for the malignancy.

In the ICD-10-CM Alphabetic Index look for Dehydration > E86.0, confirm in tabular.

In the ICD-10-CM Table of Neoplasms look for Neoplasm, neoplastic > Bone. Use the code from the Malignant Secondary Column, which directs C79.51.

Also in the Table of Neoplasms, look for unknown or unspecified site and use the code from the Malignant Primary Column, which directs to C80.1. Verify the codes in the Tabular List.

Question 18: A patient with metastatic bone cancer (primary site unknown) is admitted for severe dehydration due to her malignancy. The patient is admitted to the hospital for intravenous hydration. What ICD-10-CM is the principal diagnosis?

Correct answer: E86.0

Rationale: Per ICD-10-CM guideline I.C.2.c.3, when the admission/encounter is for management of dehydration due to the malignancy, and only the dehydration is being treated (intravenous hydration), the dehydration is sequenced first, followed by the code(s) for the malignancy.

In the ICD-10-CM Alphabetic Index look for Dehydration > E86.0, confirm in tabular.

Question 19:

A patient is admitted for diabetic ketoacidosis and diabetic coma due to malignant neoplasm of the pancreatic head. The patient uses insulin on a daily basis at home and it is continued in the hospital. What 3 ICD-10-CM codes are reported?

Correct answers: E08.11, Z79.4, C25.0

Rationale: The patient’s diabetes is due to the pancreatic cancer as an underlying condition. In the ICD-10-CM Alphabetic Index look for Diabetes, diabetic (mellitus) (sugar) > due to > underlying condition > with > ketoacidosis > with coma > E08.11. Confirm in the Tabular. In the Tabular List, under category code E08, an instructional note indicates to code the underlying condition first. 

In the Table of Neoplasms look for Neoplasm, neoplastic > Pancreas > Head and select the code from the Malignant Primary Column, which directs to C25.0. There is also coding guidance under category code E08 to use additional code for patients who routinely use insulin. Report code Z79.4. Refer to Alphabetic Index: Long-term (current) (prophylactic) drug therapy (use of) > Insulin > Z79.4. Verify the code in the Tabular List. 

Question 20: A patient is admitted for diabetic ketoacidosis and diabetic coma due to malignant neoplasm of the pancreatic head. The patient uses insulin on a daily basis at home and it is continued in the hospital. What ICD-10-CM code is the principal diagnosis?

Correct answer: C25.0

Rationale: The patient’s diabetes is due to the pancreatic cancer as an underlying condition. In the ICD-10-CM Alphabetic Index look for Diabetes, diabetic (mellitus) (sugar) > due to > underlying condition > with > ketoacidosis > with coma > E08.11. Confirm in the Tabular. In the Tabular List, under category code E08, an instructional note indicates to code the underlying condition first. 

In the Table of Neoplasms look for Neoplasm, neoplastic > Pancreas > Head and select the code from the Malignant Primary Column, which directs to C25.0. There is also coding guidance under category code E08 to use additional code for patients who routinely use insulin. Report code Z79.4. Refer to Alphabetic Index: Long-term (current) (prophylactic) drug therapy (use of) > Insulin > Z79.4. Verify the code in the Tabular List. 

Question 21: Patient is admitted for excision of a right adrenal tumor. Patient also has hypertension due to Cushing’s syndrome. What 3 ICD-10-CM Codes are reported?

Correct answers: D49.7, E24.9, I15.2

Rationale: We are not given information as to a specific type of adrenal tumor and whether it is benign or malignant. In the ICD-10-CM Alphabetic Index look for Tumor > See also Neoplasm, unspecified behavior, by site. In the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic > Adrenal > Use the code from the Unspecified Behavior Column, directing to D49.7.  

Alphabetic Index: Find Syndrome > Cushing’s > E24.9. The unspecified code for Cushing’s syndrome is used because we are not given the specific type of Cushing’s the patient has.

The Cushing’s syndrome is associated to the hypertension. Alphabetic Index: Hypertension > Due to > Endocrine Disorder > I15.2. Verify all codes in the Tabular List.

Question 22: Patient is admitted for excision of a right adrenal tumor. Patient also has hypertension due to Cushing’s syndrome. What ICD-10-CM Code is the principal diagnosis?

Rationale: We are not given information as to a specific type of adrenal tumor and whether it is benign or malignant. In the ICD-10-CM Alphabetic Index look for Tumor > See also Neoplasm, unspecified behavior, by site. In the ICD-10-CM Table of Neoplasms for Neoplasm, neoplastic > Adrenal > Use the code from the Unspecified Behavior Column, directing to D49.7.  

D49.7 is the correct Principal diagnosis because the patient presented for definitive/surgical resection of the adrenal tumor.

Question 23: Patient is admitted to the hospital for treatment of anemia that is due to cancer. What is the principal diagnosis?

Correct answer: The cancer diagnosis code

Rationale: Chapter 2 ICD-10-CM Coding Guideline

“Anemia associated with malignancy: When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia (such as code D63.0, Anemia in neoplastic disease).”

Question 24: When a patient is admitted for anemia due to chemotherapy, what is the principal diagnosis.

Correct answer: The anemia diagnosis code

Rationale: Chapter 2 ICD-10-CM Coding Guideline

Anemia associated with chemotherapy, immunotherapy and radiation therapy

When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, the anemia code is sequenced first followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5-, Adverse effect of antineoplastic and immunosuppressive drugs).

Question 25: When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by adjunct chemotherapy or radiation treatment during the same episode of care, what is the principal diagnosis?

Correct answer: The neoplasm site being surgically treated

Rationale: Chapter 2 ICD-10-CM Coding Guideline

Episode of care involves surgical removal of neoplasm

When an episode of care involves the surgical removal of a neoplasm, primary or secondary site, followed by adjunct chemotherapy or radiation treatment during the same episode of care, the code for the neoplasm should be assigned as principal or first-listed diagnosis.