Sunday, September 6, 2009

Neoplasm ICD Coding


An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Neoplasms may be benign (not cancer), or malignant (cancer). Also called tumor.

Neo means new and plasm means growth. Neoplasm is a type of cancer. Cancer of 2 types benign and malignant.
Benign:- Tumor that doesn’t spread and can be cured by excision {surgical removal}
Malignant:- Tumor that spread, there will be continuous growth and difficulty to cure. The spreading of tumor is known as metastasis. It spread through blood and lymph fluid..

Coding Rules:-

1st indentified the behavior.
2nd locate the site.

Neoplasm behavior:- ICD-9-CM classifies malignant neoplasm as primary, secondary and carcinoma in situ.

Primary:- identifies the site{location} of origin of the neoplasm. Determination of patient’s origin and type of cells is important to find the severity of illness and planning treatment.

Secondary:- indentifies the site to which the primary site has spread by direct extension to surrounding tissues.

Carcinoma in situ:- it doesn’t spread beyond the point of origin { it’s a tumor cells which are undergoing malignant changes, these changes don’t extend}

Uncertain behavior:- not yet tested. {tumors which show features of both benign and malignant behavior.

Metastatic from and of :- site is primary
Metastatic to:- site is secondary
Assign the code 199.1 when secondary site is not mentioned.
For examples:-

Metastatic carcinoma to the liver
Px: primary site Sx: secondary site
Code: Px: 199.1 Sx: 197.7

Metastatic carcinoma of the pancreas
Code: Px: 157.9 Sx: 199.1

Metastatic carcinoma from the breast
Code: Px: 174.9 Sx: 199.1

Metastatic carcinoma of brain and lung
Code brain and lung as secondary site, assign the code 199.1 as primary site is not specified.
Codes:- Px: 199.1
Sx 1: 198.3 {brain}
Sx 2: 197.0 {lung}

Metastatic renal cell carcinoma of the lung
Code first primary site as renal cell carcinoma then code Secondary site as lung.
Codes: Px: 189.0 {renal cell}
Sx: 197.0 {lung}
Carcinoma of the oral cavity and pharynx
Notes: when the patient of origin can’t be determined because the neoplasm overlaps the boundaries of 2 or more contiguous [adjacent] site, it’s classified to 4th digit “8”
Code: 149.8 [Malignant neoplasm of lip, oral cavity and pharynx whose point of origin can’t be assigned to any one of the categories.]

Metastatic carcinoma of retroperitoneum and peritoneum
Code: Px: 199.1
Sx: 197.6 [retro+ peritoneum code only once]
Metastatic carcinoma of the ovary

Code: Px: 183.0
Sx; 199.1