Find & assign the proper cancer & associated condition codes June 2018 Breakdown of Chapter Two Codes Type of Neoplasm Description C00-C75 Malignant primary A malignant tumor is one that grows quickly and destructively invades the surrounding tissue. The primary neoplasm is the site where the cancerous cells are believed to have originated. C76-C80 Malignant secondary A malignant tumor (see above). A secondary neoplasm is one where the neoplastic cells from another primary site were transported through the lymphatic or circulatory system to another location. This process of spreading cancerous cells is called metastasis. C81-C96 Malignant lymphoid, A malignant tumor (see above). These neoplasms do hematopoietic and not occur in any specific site, but rather in lymphatic, related tissue blood and related tissue. Breakdown of Chapter Two Codes Neoplasm Type Description D00-D09 Carcinomas A contained neoplasm which is undergoing malignant in situ changes but has not invaded the surrounding tissue. D10-D36 Benign A neoplasm that is neither growing excessively nor causing destruction in the surrounding cells. Even so, it may cause dysfunction due to its size or its effect on adjacent tissue. D37-D48 … of uncertain A neoplasm in which a cellular examination proves unable behavior to determine whether the neoplasm is malignant or not. D49 … of unspecified A neoplasm for which the documentation does not state behavior the nature of the neoplasm and the coder cannot assign anything more specific. Query the physician for more information before assigning. Neoplasm Sequencing TREATMENT DIRECTED AT: M1021 M1023 Primary neoplasm (still Primary neoplasm Secondary neoplasm if present) malignancy has metastasized Secondary neoplasm, primary Secondary neoplasm Primary neoplasm still present Secondary neoplasm, primary Secondary neoplasm Assign personal history code excised from Z85.- Anemia due to neoplasm – Neoplasm D63.0 (Anemia in neoplastic treatment only for anemia disease) Anemia due to antineoplastic D64.81 (Anemia due to Neoplasm code followed by chemotherapy or antineoplastic T45.1X5 (Adverse effect of immunosuppressive therapy chemotherapy) antineoplastic drugs) Admission for neoplasm- G89.3, (Neoplasm Neoplasm related pain control only associated pain) 7 Other Guidelines Overlapping lesions and multiple neoplasms same site – Section I.C.2 A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 ('overlapping lesion'), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous such as tumors in different quadrants of the same breast, codes for each site should be assigned. Treatment of secondary site – Section I.C.2.b When a patient is admitted because of a primary neoplasm with metastasis and treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal dx even though the primary malignancy is still present. Other Guidelines Management of dehydration due to the malignancy – Section 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 rehydration), the dehydration is sequenced first, followed by the code(s) for the malignancy. Complication from surgical procedure for treatment of a neoplasm – Section I.C.2.l.4) When an encounter is for treatment of a complication resulting from a surgical procedure performed for the treatment of the neoplasm, designate the complication as the principal/first-listed diagnosis. See guideline regarding the coding of a current malignancy versus personal history to determine if the code for the neoplasm should also be assigned. Other Guidelines Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission versus personal history – Section I.C.2.n The categories for leukemia, and category C90, Multiple myeloma and malignant plasma cell neoplasms, have codes indicating whether or not the leukemia has achieved remission. There are also codes Z85.6, Personal history of leukemia, and Z85.79, Personal history of other malignant neoplasms of lymphoid, hematopoietic and related tissues. If the documentation is unclear as to whether the leukemia has achieved remission, the provider should be queried. Cancer Coding Tips • Remember to first look in the Alphabetic Index before verifying the code in the tabular, per the official coding guidelines [I.B.1]. For neoplasms that aren’t specified by their histology and that are generally referred to as neoplasms or cancer, the index will lead you to the neoplasm table. • Avoid assigning an incomplete neoplasm code and risk having the claim reject. Neglecting to specify the laterality of a patient’s cancer is a common mistake. • Do not assign a code for a neoplasm of uncertain behavior unless the physician has specified it as such. A neoplasm described as “of uncertain behavior” means a biopsy has been performed but the histology couldn’t be determined. • Look for language in the record that indicates the patient’s tamoxifen regimen is being given prophylactically, which means that it’s being used for prevention instead of active treatment..