Neoplasms Chapter II

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NeoplasmsChapter II

• HS317b - Coding Classification of Health
  Information

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Neoplasm

• Can occur in all body systems
• Can be classified by anatomical site, behaviour
  and morphology.
• To code neoplasms think in terms of the disease
  process

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Coding Rules for Neoplasms

• MRDx is based on what site they are treating
  (primary or secondary)
• Apply specificity standard
• Assign separate codes for each primary and
  secondary
• Morphology coding is optional
• C80 Malignant neoplasm without specification if
  documentation is vague

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Primary Neoplasm

• Code to point of origin
• This includes when cancer invades into adjacent
  tissue and is still connected to original site
• Be as specific as documentation allows
• Code to site

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Example Ca of the small intestine

• C17 Malignant neoplasm of small intestine
• Duodenum (C17.0)
• Jejunum (C17.1)
• Ileum (C17.2)
• Meckels diverticulum (C17.3)

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Overlapping Boundaries (contiguous sites)

• Within a 3-digit category point of origin is
  underdetermined
• Example
• C17.8 Overlapping malignant lesion of small
  intestine

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Overlapping sites within certain systems

• Overlaps the boundaries of three-character
  categories within certain systems. See note at
  beginning of neoplasm chapter
• E.g. Ca of stomach (C16.) and small intestine
  (C17.)
• C26.8 Overlapping lesion of digestive system

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Overlapping systems

• C02.8 Overlapping lesion of tongue
• C08.8 Overlapping lesion of major salivary glands
• C14.8 Overlapping lesion of lip, oral cavity and
  pharynx
• C21.8 Overlapping lesion of rectum, anus and anal
  canal
• C24.8 Overlapping lesion of biliary tract,
• C26.8 Overlapping lesion of digestive system
• C39.8 Overlapping lesion of respiratory and
  intrathoracic organs
• C41.8 Overlapping lesion of bone and articular
  cartilage
• C49.8 Overlapping lesion of connective and soft
  tissue
• C57.8 Overlapping lesion of female genital organs
• C63.8 Overlapping lesion of male genital organs
• C68.8 Overlapping lesion of urinary organs
• C72.8 Overlapping lesion of central nervous system

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Metastatic Neoplasms

• When solid malignant neoplasms spread to other
  sites through local invasion of adjacent sites,
  metastasis to distant sites or seed.
• ICD-10 does not make a distinction between method
  of metastasis.
• This excludes local invasion into tissue within a
  body system (Code to point of origin).
• Other terminologysecondary neoplasm

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Lymphomas and Leukemia

• These neoplasms do not metastasize to secondary
  sites. They circulate within the lymphatic or
  hematopoetic circulation and may occur in other
  sites within these tissues.
• Assigned to morphology rather than site.

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Admissions following diagnosis of CA

• Patient admitted for definitive surgery to remove
  tissue from site of previous biopsy pathology
  report is negative for malignancy.
• MRDx is primary neoplasm
• i.e. Ca of breast. For diagnosing purposes a
  needle biopsy of lump shows CA. Patient admitted
  for lumpectomy pathology was negative for
  malignancy

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Follow up admissions

• Various scenarios can be encountered to allow one
  to code history or follow up codes
• Recurrent malignancies
• Interventions after diagnosis of Ca made
• Observation for suspected malignancy
• History of malignant neoplasms
• Chemotherapy/Radiation
• Prophylactic interventions

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Recurrent Malignancies

• Example
• Ca of right breastlumpectomy removed entire
  lesion
• A year later returns with lesion at site of
  previous lumpectomy. According to documentation
  this is a recurrence of the primary malignancy.
• Ca previously eradicated but recurrent in the
  same organ or tissue
• Code as primary (unless documentation directs you
  differently)
• Include code for history of malignancy
• C50.90 Ca R breast Z85.3 Personal history of
  malignant neoplasm of breast

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Observation for suspected CA

• When a patient presents with symptoms but tests
  prove negative for malignancy
• Malignancy is ruled out
• No further treatment is necessary
• Code
• Z03.1 Observation for suspected malignant neoplasm

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History of Malignant Neoplasms

• Different scenarios
• Personal history of malignancy
• Follow up examinations after initial intervention
• Family history of malignancy

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Personal History Z85.

• Never to be used as MRDx
• Always assign diagnosis type 3
• Only assign for primary malignancies
• When Ca has been completely eradicated/excised
• No further treatment directed toward primary
• No evidence of any remaining Ca at primary site
• There is a recurrence at same site that was
  previously excised

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Follow up Examination

• When no disease is found
• Through follow up investigation
• No treatment indicated
• MRDx Z08. Follow-up examination after
  treatment for malignant neoplasm
• Diagnosis type 3 Z85. Personal history of Ca

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Family History of Ca

• Z80. Family history of malignant neoplasm
• Never used as MRDx
• Assign diagnosis type 3
• Denotes reason for prophylactic organ removal

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Prophylactic Organ Removal

• There is a family history of malignancy
• Z80. Family history of malignant neoplasm
• Tests like PSA (Prostate Specific Antigen) or CA
  125 (Cancer Antigen) positive
• No disease is present
• MRDx Z40. Prophylactic organ removal

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Complications of Malignancy

• If complications are the cause of admission
• Complication is MRDx
• Malignancy is coded assigned diagnosis type 3
• Common complications
• Bacterial sepsis
• Chemotherapy induced neutropenia
• Febrile neutropenia
• Dehydration
• Hypercalcemia

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Neutropenia

• An abnormally low level of neutrophils in the
  blood.
• Neutrophils are white blood cells produced in the
  bone marrow that ingest bacteria.

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Neutropenia

• It is sometimes called agranulocytosis or
  granulocytopenia.
• It is a serious disorder because it makes the
  body vulnerable to bacterial fungal infections.

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• Neutropenia may result from three processes
• Decreased WBC production
• Destruction of WBCs
• Sequestration and margination of WBCs

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• Recovery from acute neutropenia depends on the
  severity of the patient infection the
  promptness of treatment.
• When both neutropenia fever are documented in
  the chart, code both D70.0 Neutropenia R50.9
  Fever, unspecified.

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Dagger /Asterisk Standard

• Dual Combination for circumstances when there are
  two codes for diagnostic statements containing
  information about both an underlying generalized
  disease and a manifestation in a particular organ
  or site which is a clinical problem in its own
  right.
• code marks the primary code for the underlying
  disease
• code marks the manifestation code.

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Dagger /Asterisk

• Dagger may be MRDx, diagnosis type 1, 2 or 3.
• Asterisk is always diagnosis type 3 and may
  never be used alone.
• in, due to or with
• Anaemia in neoplastic disease
• D63.0 Anaemia in neoplastic disease (C00-D48)

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Folio Lookup

• Cancer - see also Neoplasm, malignant (8000/3)

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8000/3 Morphology Classification

• Describes the cell of origin (histological type)
• Describes the behaviour of the neoplasm
• Optional to use
• Always Diagnosis type 4
• When morphology diagnosis contains two qualifying
  adjectives, the higher should be used

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• Five digits
• First four identify histological type of
  neoplasm
• 8000 Neoplasm
• 8140 Adenocarcinoma NOS
• 8140 Adenocarcinoma, metastatic NOS

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• /Fifth indicates behaviour
• /0 Benign
• /1 Uncertain whether benign or malignant
• /2 Carcinoma in situ
• /3 Malignant, primary site
• /6 Malignant, metastatic site
• /9 Malignant, uncertain whether primary or
  metastatic

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Review of Coding Neoplasms

• Code to point of origin
• Has the malignancy been either excised or
  eradicated?
• Is no further treatment being directed to the
  primary site?
• Is there no further evidence of remaining
  malignancy at the primary site.
• Account for primary with either malignant code or
  history of code

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Interventions

• Therapeutic
• Destruction, excisional partial, excisional
  total, excisional radical or excision with
  reconstruction
• Diagnostic
• Inspections (endoscopy) biopsies

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• Chemotherapy
• MRDx is Z51.1 Chemotherapy session for neoplasm
• Neoplasms (active historical malignancies) may
  be coded as diagnosis type 3
• Intervention 1.ZZ.35. (identify specific
  drug) for systemic or total chemotherapy

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• Radiation
• MRDx is Z51.0 Radiotherapy session
• Neoplasm (active historical malignancies) may
  be coded as diagnosis type 3)
• Intervention 1. . 27. Radiation therapy
  includes anatomical site type of radiation.

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• Brachytherapy
• MRDx is malignancy
• Intervention is 1.QT. 26. (implant of
  radioactive material)

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Classification of Neoplasm MRDx

• MCC 17 Lymphoma, Leukemia or unspecified site
  neoplasms
• MCC 17A Lymphoma or leukemia
• Bone marrow transplant will be assigned to CMG
  700 Bone Marrow Transplant
• CMG 725 Major Leukemia and Lymphoma Procedures
• Open biopsies, Ventricular shunts, Excisions

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Classification of Neoplasm MRDx

• MCC 17B Neoplasms of unspecified site
• Medical partition Radiation CMG 735,
  Chemotherapy CMG 736
• Similar surgical procedures as MCC17A