VIDEO — Neoplasm Coding

One of our students have asked to review neoplasm coding from the ICD 9 manual.

If you have your ICD 9 book handy, this is in the index if you go to the Ns for Neoplasm. The first thing you want to remember about cancer coding or neoplasm coding is the fact that really, you should not start with the neoplasm table. And this was kind of new for me. I had actually been teaching a couple of years before I actually realized that you should look for the main term in the document that you’re coding like melanoma or whatever. You go to that first. 9 times out of 10, it will direct you to neoplasm and the table but always start with the main term that you’re trying to code and let the index direct you to the neoplasm table.

Neoplasm Coding Video

So once you come to the neoplasm table, what I want you to look at first is these columns. Okay so there’s… in neoplasm… here you go, Jane. Here’s medical terminology, right? Means new growth. It doesn’t mean cancer. It could be but it means that there’s a new growth. So we see here that there’s 3 types of malignant cancers: primary, secondary, and cancer in situ. The primary type is it’s a spreadable type of cancer. And secondary is where it spreads to so you’ll see in the documentation, phrases like ‘with mets’. So maybe they had breast cancer with mets to the liver or with mets to the lungs or something like that. So the primary cancer would be the breast and the secondary cancer would be the lungs or the liver.

Okay, cancer in situ is cancer that’s not the spreadable type. It’s kind of encapsulated. Another instructor tells her students to think of an egg, it’s like the yolk in an egg. So it’s encapsulated, it’s not going anywhere.

Then we’ve got benign neoplasms which is self-explanatory. Uncertain behavior, they’re not sure they’re watching it and then unspecified. They just know that it’s a neoplasm but they don’t know. A lot of times, coders will wait for the path report to come back to code it as primary or secondary or whatever type cancer it is. But sometimes, they don’t know. They don’t plan on documentation coming back to code from so they code it as unspecified.

So once you determine what type of cancer or neoplasm you’re dealing with, that’s the column that you’re going to use. So let me scroll down a little bit here. So let’s just take abdomen and I’m just going to use the top row for illustration purposes. So if the cancer started in the abdomen, if that was the primary location, you’re going to pull from this first column. Encode at the 195.2 because that’s the primary column.

But let’s say it spread to… I’m just trying to stay on the same page here. But if it spread, if it was a secondary cancer of the abdominal pelvic area, let’s say. You’re going to code from the second column, 198.89. And that’s how easy it is to pull from these columns. They still turn to the tabular and look at the code definition and confirm that you’ve got the right code that you’re looking for. Don’t just code from the table.

What gets confusing with secondary cancer coding and you might want to copy this into your book, for those that are in the Replay Club, you’ll get a copy of this PDF here… is secondary cancer coding. How do you handle that? If a patient’s coming in for treatment of the secondary cancer, that’s going to go on the first position on the claim form. Okay so you’re going to pull from the secondary column. That’s going to go on the first position.

Then the next logical question is well, since it’s a secondary cancer, where did it come from? Where did it spread from? So that is going to go on the second position on the claim form, the second diagnostic slot.

So if the primary cancer is still active then you’re going to pull from the primary column. It’s just going to go on the second position. If it’s been excised and it’s not under treatment, it’s history of… you’re going to use a V code. Maybe they had a mastectomy. So then it’s going to be hsitory of breast cancer and now you’re treating liver cancer. So you pull the liver cancer from the secondary column and for the… that goes in the first position and the second position on the claim form, you’re going to code the V code for history of breast cancer.

If you don’t know where it metastasized from because maybe you’re coding for radiology and they don’t know. They’re just doing a brain scan or a liver scan. Then they have to use 199.1 which I have circled here. That’s the unspecified primary site. Okay so that’s how you handle the secondary cancer coding.

Now another thing that I always like to let my students to be aware of is this… in the note section, if you look at number 2 here, it says sites marked with the asterisk should be classfied as one of two things: either it’s a malignant neoplasm of the skin or it’s a benign neoplasm of the skin. Now it’s malignant if it’s a squamous cell carcinoma. So if ithat’s what’s documented you concider it malignant neoplasm of the skin. If it’s an epidermoid carcinoma, same thing. It’s a malignant neoplasm of the skin.

Now if it’s a papilloma then that’s considdred a benign neoplasm. So make sure that you have this marked up for the skin ones. Let me see if there’s any starred ones on this page. No sorry, I don’t have any examples. But it would be an asterisk and you know because sometimes, it’ll be abdominal. It’s like, “Okay, are you telling me about the skin of the abdomen or you’re talking about internal organs of the abdomen?” So that’s what the star would help you understand.

Boyd: Do you go over this at all in the Blitz course? It’s just being asked by Linda.

Laureen: That’s… I do cover that in the Blitz because I do feel that that is a question that you’ll be asked on the board exam, especially the secondary cancer coding.

Related Neoplasm Coding Training

• ICD 10 Coding Training Certification
• Medical Coding Training
• Sequence coding for Neoplasm Coding- AAPC