Chapter 2: Neoplasms (C00-D49) – Coding Cases Answers with Rationales

1.

C34.32 Carcinoma (malignant), see also Neoplasm, by site, malignant. Refer to Neo-plasm Table, by site, lung, lower lobe, Malignant Primary, Review the Tabular for complete code assignment.

C77.1 Refer to Neoplasm Table, by site, lymph, lymphatic channel NEC, gland, in-trathoracic, Malignant Secondary

C79.31 Refer to Neoplasm Table, by site, brain NEC, Malignant Secondary

C79.51 Refer to Neoplasm Table, by site, bone, rib, Malignant Secondary

Rationale: The primary site is the small cell carcinoma of the left lower lobe of the lung. The intrathoracic lymph nodes, brain, and rib are secondary sites. Index the term Carcinoma because the histological term is documented. This refers you to the Neoplasm Table, by site, malignant. It is correct to list each metastatic site so complete data is captured of the patient’s condition.

2.

D3A.010 Carcinoid (tumor), see Tumor, carcinoid, benign, duodenum

Rationale: When indexing Carcinoid, the note directs to Tumor. It is not necessary to use the Neoplasm Table to code this tumor. Under Carcinoid, there is a differentiation between benign or malignant, with specific sites listed. Benign carcinoid tumors fall into category D3A, Benign neuroendocrine tumors. The following notes are present: Code also any associated multiple endocrine neoplasia [MEN] syndromes; and Use additional code to identify any associate endocrine syndrome, such as Carcinoid syndrome (E34.0).

3.

C93.91 Leukemia, leukemic, monocytic (subacute). Review the Tabular for complete code assignment.

Rationale: Leukemia is not coded from the Neoplasm Table, but rather indexed under the term Leukemia. Monocytic is classified to subcategory C93.9-. The Tabular List is consulted to complete the code with the 5th character of ‘1’ that indicates ‘in remission’.

4.

C43.52 Melanoma (malignant), skin, breast (female) (male)

C43.61 Melanoma (malignant), skin, arm. Review the Tabular for complete code assignment.

Rationale: To code Melanoma, the code is found directly in the Index rather than the Neoplasm Table. It is incorrect to assign primary site of skin (C44.52, C44.61) when melanoma is documented.

5.

E86.0 Dehydration

G89.3 Pain(s) (see also Painful), chronic, neoplasm related

C50.311 Carcinoma (malignant), see also Neoplasm, by site, malignant. Refer to Neo-plasm Table, by site -breast-, lower-inner quadrant, Malignant Primary. Re-view the Tabular for complete code assignment.

C78.7 Refer to Neoplasm Table, by site, liver, Malignant Secondary

Rationale: ICD-10-CM chapter-specific guideline for neoplasms (I.C.2.c.3) states that when the encounter is for management of dehydration due to the malignancy and only the dehydration is being treated, the dehydration is sequenced first, followed by the code(s) for the malignancy. An additional ICD-10-CM Coding Guideline (I.C.6.b.5) states that when the reason for the encounter is for neoplasm-related pain control or pain management, the pain code may be assigned as the first-listed diagnosis. Because the focus of this encounter was both the dehydration and the intractable pain, either may be sequenced first.

6.

C79.31 Refer to Neoplasm Table, by site, brain NEC, Malignant Secondary

Z85.3 History, personal (of), malignant neoplasm (of), breast

Z90.11 Absence (of) (organ or part) (complete or partial), breast(s) (and nip-ple(s))(acquired). Review the Tabular for complete code assignment

Z92.21 History, personal (of), chemotherapy for neoplastic condition

Rationale: The reason for this encounter is the metastatic brain cancer. The breast cancer was previously excised with no further treatment directed at that site; therefore, it is coded as history of breast cancer. Because the patient had a previous mastectomy, a code for the acquired absence of the breast is also coded. Laterality can be specified in the Z90.1 subcategory. It was documented that the brain metastasis was causing the symptoms, so the symptoms are not assigned additionally. If it is not clear by the documentation, a query might be in order. There is also a code available for history of chemotherapy if the facility takes coding to that level of detail.

7.

Z51.11 Chemotherapy (session) (for), cancer

C18.8 Carcinoma (malignant), see also Neoplasm, by site, malignant. Refer to Ne-oplasm Table, by site, intestine, large, overlapping lesion, Malignant Prima-ry

Z90.49 Absence (of) (organ or part) (complete or partial), intestine (acquired) (small), large

Rationale: The reason for the encounter (chemotherapy) is the first-listed diagnosis. The neoplasm is coded as current (even though it was excised) because the patient is still receiving chemotherapy. The overlapping sites code is used because the cancer is part in the duodenum and part in the jejunum. The acquired absence of the small intestine may be coded because the category includes the organ or part, complete or partial.