ICD-10 Coding/Neoplasms

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This lesson introduces ICD-10-CM Neoplasms.

Objectives and Skills[edit]

Objectives and skills for this lesson include:

  1. Apply ICD-10-CM coding guidelines for accurate selection and sequencing of diagnosis codes commonly used to describe neoplasms
  2. 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.

Start Here[edit]

ICD-10-CM Official Guidelines for Coding and Reporting FY2019[edit]

Chapter 2 specific guidelines can be found on pages 29-36 of this document

Part 1: Diagnoses[edit]

CG I.C.2. Chapter 2: Neoplasms (C00-D49) General guidelines[edit]

CG I.C.2.a. Treatment directed at the malignancy[edit]
CG I.C.2.b. Treatment of secondary site[edit]
CG I.C.2.c. Coding and sequencing of complications[edit]
CG I.C.2.c.1) Anemia associated with malignancy[edit]
CG I.C.2.c.2) Anemia associated with chemotherapy, immunotherapy and radiation therapy[edit]
CG I.C.2.c.3) Management of dehydration due to the malignancy[edit]
CG I.C.2.c.4) Treatment of a complication resulting from a surgical procedure[edit]
CG I.C.2.d. Primary malignancy previously excised[edit]
CG I.C.2.e. Admissions/Encounters involving chemotherapy, immunotherapy and radiation therapy[edit]
CG I.C.2.e.1) Episode of care involves surgical removal of neoplasm[edit]
CG I.C.2.e.2) Patient admission/encounter solely for administration of chemotherapy, immunotherapy and radiation therapy[edit]
CG I.C.2.e.3) Patient admitted for radiation therapy, chemotherapy or immunotherapy and develops complications[edit]
CG I.C.2.f. Admission/encounter to determine extent of malignancy[edit]
CG I.C.2.g. Symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasms[edit]
CG I.C.2.h. Admission/encounter for pain control/management[edit]
CG I.C.2.i. Malignancy in two or more noncontiguous sites[edit]
CG I.C.2.j. Disseminated malignant neoplasm, unspecified[edit]
CG I.C.2.k. Malignant neoplasm without specification of site[edit]
CG I.C.2.l. Sequencing of neoplasm codes[edit]
CG I.C.2.l.1) Encounter for treatment of primary malignancy[edit]
CG I.C.2.l.2) Encounter for treatment of secondary malignancy[edit]
CG I.C.2.l.3) Malignant neoplasm in a pregnant patient[edit]
CG I.C.2.l.4) Encounter for complication associated with a neoplasm[edit]
CG I.C.2.l.5) Complication from surgical procedure for treatment of a neoplasm[edit]
CG I.C.2.l.6) Pathologic fracture due to a neoplasm[edit]
CG I.C.2.m. Current malignancy versus personal history of malignancy[edit]
CG I.C.2.n. Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission versus personal history[edit]
CG I.C.2.o. Aftercare following surgery for neoplasm[edit]
CG I.C.2.p. Follow-up care for completed treatment of a malignancy[edit]
CG I.C.2.q. Prophylactic organ removal for prevention of malignancy[edit]
CG I.C.2.r. Malignant neoplasm associated with transplanted organ[edit]

Part 2 : Procedures[edit]

Excision, Resection, or Destruction of a body part

Excision vs Resection

-      Excision[1] – sentinel lymph removed

-      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

Learning Resources[edit]

Cancer Screening

Cell Cycle : Cancer[2]

Characteristics / Classifications of Neoplasms PPT [3]

How to become a Cancer Registry Professional? Website [4]

Common Surgical Procedures[5]


Cancer Pathophysiology Quiz[6]

Visit the following the National Cancer Institute website[7] and answer the following question: What is cancer?

Check your understanding:

  • 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:[9]
    • 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).
Malignant melanoma

What does term “Malignant[10]” mean?

  • Tending to become worse and cause death
  • Describing a cancer
  • Resistant to treatment

Summary and Key Terms[edit]

Bam Table/Image

BAM Table:

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”

See Also[edit]


Reporting Pain in ICD-10-CM[12]

Chemotherapy Dosage


  1. Whitlock, Jennifer; RN; MSN; May 29, FN | Updated; 2018. "How and Why Excisions Are Performed During a Surgery". Verywell Health. Retrieved 2019-05-10.
  2. Cancer, retrieved 2019-05-10
  3. Subramani Parasuraman (2013-10-20). Neoplasia Characteristics and classification of cancer. https://www.slideshare.net/ParasuramanParasuraman/neoplasia-1-27391892. 
  4. BECOMING A CANCER REGISTRY PROFESSIONAL - SEER REGISTRARS In-text: (SEER, 2019) Your Bibliography: SEER. (2019). Becoming a Cancer Registry Professional - SEER Registrars. [online] Available at: https://seer.cancer.gov/registrars/howto.html [Accessed 10 May 2019].
  5. "Surgical Procedures". Verywell Health. Retrieved 2019-05-10.
  6. "Cancer Pathophysiology Quiz". Health Information Technology Notifications | HITNOTS. 2015-07-14. Retrieved 2019-05-10.
  7. "What Is Cancer?". National Cancer Institute. 2007-09-17. Retrieved 2019-05-10.
  8. "Remission vs. Relapse". Sarah Cannon. Retrieved 2019-05-10.
  9. "Acrobat Accessibility Report" (PDF). www.cms.gov. Retrieved 2019-05-10.
  10. "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Retrieved 2019-05-10.
  11. "ICD-10 Chapter II: Neoplasms" (in en). Wikipedia. 2018-05-10. https://en.wikipedia.org/w/index.php?title=ICD-10_Chapter_II:_Neoplasms&oldid=840572757. 
  12. "Reporting Pain in ICD-10-CM". Coding Strategies. Retrieved 2019-05-10.