Types of
neoplasm
1. Benign
(Non-cancerous)
2. Malignant
(Primary and Secondary)
3. Ca
in situ (Cancerous)
4. Uncertain
behavior (Benign nature to Malignancy)
5. Unspecified
The neoplasm table in the Alphabetic Index should be referenced
first.
However, if the
histological term is documented, that term should be referenced first index of
disease, then search in the Neoplasm Table.
Eg: Adenoma,
Sarcoma, Fibroma, Androblastoma etc..
It is very
important to select the proper column in the neoplasm table to the respective
type of neoplasm.
Sequencing:
1. Based
on the encounter, assign it to the primary and secondary diagnosis.
A. If the patient is having both primary
and secondary neoplasm and treatment is for the primary site, then assign
primary site as the first diagnosis followed by metastatic.
B. If the patient is having
both primary and secondary neoplasm and treatment is for the secondary site,
and then assign secondary neoplasm as the first diagnosis followed by the
primary neoplasm.
2. When
a primary malignancy has been excised but further treatment, such as an
additional surgery for the malignancy, radiation therapy or chemotherapy is
directed to that site, the primary malignancy code should be used until
treatment is completed.
3. If
the primary malignancy has been previously excised from its site and there is
no further treatment required to that site, a code from category Z85 (Personal
history of malignant neoplasm) should be used.
Any metastasis
to another site is coded as a secondary malignant neoplasm to that site. The
secondary site may be the principal diagnosis with Z85.
4. Anemia associated
with malignancy and the treatment is only for anemia, The malignancy is
sequenced first followed by anemia code (D63.0)
5. Dehydration due
to the malignancy and only the treatment is for dehydration, the dehydration is
sequenced first followed by malignancy code.
6. Pathological
fracture due to a neoplasm,
A. If an encounter is for pathological
fracture, a code from subcategory M84.5 (pathological fracture due to neoplasm)
should be sequenced first, followed by the code for the neoplasm.
B. If an encounter is for
neoplasm, it should be sequenced first followed by M84.5
7. Surgical
removal of neoplasm followed by chemo/radiation therapy during the same episode
of care, Neoplasm should be sequenced first.
8. If
the encounter is for chemo/immune/radiation therapy, use ‘Z’ primary code.
Z51.0 (Encounter
for antineoplastic radiation therapy)
Z51.11 (Encounter
for antineoplastic chemotherapy)
Z51.12 (Encounter
for antineoplastic immunotherapy)
The malignancy for which therapy is given should be used as a second code.
If any complication develops, it would be assigned as the secondary code.
9. C80.1
(Malignant neoplasm) Unspecified.
10. C80.0 (Disseminated
malignant neoplasm).
11. Malignant
neoplasm in pregnancy patient, Use O9A.1 – (Malignant neoplasm complicating
pregnancy, childbirth, and the puerperium) as primary Dx followed by a code for
malignancy.
________________________________________________________________________
Test your Knowledge: