This lesson introduces ICD-10-CM Neoplasms.
Objectives and Skills
Objectives and skills for this lesson include:
- Apply ICD-10-CM coding guidelines for accurate selection and sequencing of diagnosis codes commonly used to describe neoplasms
- Apply ICD-10-PCS coding guidelines for accurate selection of procedure codes commonly used to diagnose and treat neoplasms
Guidelines Introduction Video
Chapter 2 Guidelines Powerpoint.
Chapter 2 specific guidelines can be found on pages 29-36 of this document
Part 1: Diagnoses
CG I.C.2. Chapter 2: Neoplasms (C00-D49) General guidelines
CG I.C.2.a. Treatment directed at the malignancy
CG I.C.2.b. Treatment of secondary site
CG I.C.2.c. Coding and sequencing of complications
CG I.C.2.c.1) Anemia associated with malignancy
CG I.C.2.c.2) Anemia associated with chemotherapy, immunotherapy and radiation therapy
CG I.C.2.c.3) Management of dehydration due to the malignancy
CG I.C.2.c.4) Treatment of a complication resulting from a surgical procedure
CG I.C.2.d. Primary malignancy previously excised
CG I.C.2.e. Admissions/Encounters involving chemotherapy, immunotherapy and radiation therapy
CG I.C.2.e.1) Episode of care involves surgical removal of neoplasm
CG I.C.2.e.2) Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy
CG I.C.2.e.3) Patient admitted for radiation therapy, chemotherapy or immunotherapy and develops complications
CG I.C.2.f. Admission/encounter to determine extent of malignancy
CG I.C.2.g. Symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasms
CG I.C.2.h. Admission/encounter for pain control/management
CG I.C.2.i. Malignancy in two or more noncontiguous sites
CG I.C.2.j. Disseminated malignant neoplasm, unspecified
CG I.C.2.k. Malignant neoplasm without specification of site
CG I.C.2.l. Sequencing of neoplasm codes
CG I.C.2.l.1) Encounter for treatment of primary malignancy
CG I.C.2.l.2) Encounter for treatment of secondary malignancy
CG I.C.2.l.3) Malignant neoplasm in a pregnant patient
CG I.C.2.l.4) Encounter for complication associated with a neoplasm
CG I.C.2.l.5) Complication from surgical procedure for treatment of a neoplasm
CG I.C.2.l.6) Pathologic fracture due to a neoplasm
CG I.C.2.m. Current malignancy versus personal history of malignancy
CG I.C.2.n. Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission versus personal history
CG I.C.2.o. Aftercare following surgery for neoplasm
CG I.C.2.p. Follow-up care for completed treatment of a malignancy
CG I.C.2.q. Prophylactic organ removal for prevention of malignancy
CG I.C.2.r. Malignant neoplasm associated with transplanted organ
Part 2 : Procedures
Excision, Resection, or Destruction of a body part
Excision vs Resection
- Resection – the entire lymph node chain removed
Destruction: physical eradication of all or a portion of a body part by direct use of energy, force, or a destructive agent (Ex. Laser: Radiation Therapy)
What is the root operation for “Antineoplastic chemotherapy”? Introduction
Check your understanding:
- What is the difference between “remission” and “relapse”?
- When the disease lessens in severity
- Symptoms decrease and treatment discontinued
- Return of manifestations after an interval of improvement
- May be a recurrence of the leukemia
- What is G89.3? code for neoplasm-related pain
- Where is the following guideline located ? ICD-10-CM / chapter 6 : Diseases of the Nervous System (G00 - G99)
- Coding Guideline:
- Neoplasm Related Pain Code G89.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic. This code may be assigned as the principal or first-listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis. When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not necessary to assign an additional code for the site of the pain. See Section I.C.2 for instructions on the sequencing of neoplasms for all other stated reasons for the admission/encounter (except for pain control/pain management).
- Tending to become worse and cause death
- Describing a cancer
- Resistant to treatment
Summary and Key Terms
|Behavior (6 different choices)||Anatomical Site||Morphology type|
|1) Malignant Primary||site where neoplasm originated||Lung, breast, etc.||· describes the size, shape and structure of the cells; leukemia, melanoma, sarcoma, adenocarcinoma, fibroma, glioma, etc.
If morphology is stated, coder must locate the morphology of the tumor in the Index to Diseases and Injuries
· For example, lipoma, melanoma, sarcoma have specific codes included in the Index
· However, not every entry in Index will include codes
· For example, glioma, subependymal, brain has a cross reference to – see Neoplasm, uncertain behavior, by site (brain)
|Malignant Primary with Contiguous Sites||Overlaps 2 or more contiguous sites should be classified to the subcategory/code “.8” (unless the combination is specifically indexed elsewhere||Ex: Lesion of the jejunum and ileum|
|2) Malignant Secondary||· site to which neoplasm has spread (also known as the metastatic site)
· patient may have a metastatic tumor, but the site of the primary tumor cannot be found
· “new primary” occurs when patient develops cancer a second time and is unrelated to the first cancer site
· “recurrence” is when the original cancer recurs in the same organ
· Cells of the secondary site do not resemble the cells of the organ where it was found
- Patient stated as having an unknown primary origin
- Code for secondary site where found
- Code for primary malignant of unknown site
|3) In situ (in place)||malignant changes in cells but surrounding tissue has not been invaded|
|4) Benign||tumor growth does not invade adjacent structures or spread to distant sites|
|5) Uncertain||pathologist cannot determine whether benign or malignant|
|6) Unspecified Behavior||neither the behavior nor the histology is specified in the diagnosis Ex: “Growth,” “Neoplasm,” “Tumor”|
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