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Coding Neoplasms

Audio Seminar/Webinar

April 12, 2007

Practical Tools for Seminar Learning

Disclaimer

AHIMA 2007 Audio Seminar Series i

The American Health Information Management Association makes no

representation or guarantee with respect to the contents herein and

specifically disclaims any implied guarantee of suitability for any specific

purpose. AHIMA has no liability or responsibility to any person or entity

with respect to any loss or damage caused by the use of this audio

seminar, including but not limited to any loss of revenue, interruption of

service, loss of business, or indirect damages resulting from the use of this

program. AHIMA makes no guarantee that the use of this program will

prevent differences of opinion or disputes with Medicare or other third

party payers as to the amount that will be paid to providers of service.

As a provider of continuing education the American Health Information

Management Association (AHIMA) must assure balance, independence,

objectivity and scientific rigor in all of its endeavors. AHIMA is solely

responsible for control of program objectives and content and the selection

of presenters. All speakers and planning committee members are expected

to disclose to the audience: (1) any significant financial interest or other

relationships with the manufacturer(s) or provider(s) of any commercial

product(s) or services(s) discussed in an educational presentation; (2) any

significant financial interest or other relationship with any companies

providing commercial support for the activity; and (3) if the presentation

will include discussion of investigational or unlabeled uses of a product.

The intent of this requirement is not to prevent a speaker with commercial

affiliations from presenting, but rather to provide the participants with

information from which they may make their own judgments.

Faculty

AHIMA 2007 Audio Seminar Series ii

Kathleen E. Wall, MS, RHIA, CPUR

Kathleen is a Project Manager with 3M Consulting. She has 30 years of experience in Health

Information Management, including coding and data quality. Kathleen is responsible for

coordinating and managing DRG ASSURANCE projects, coding validations, Compliance Coding

Audits and Audit Expert services.

During her career she has developed, initiated a process for and maintained quality of

coded/DRG data for a 5 hospital system in Orlando, FL leading to 98% ongoing coding/DRG

accuracy as well as demonstrating additional revenue for the hospitals. Participated in

development of client services for Audit Expert software system with positive outcomes and

facilitated client satisfaction with the product. Has performed compliance audits related to OIG-

initiated audits and self-disclosures.

Ms. Wall belongs to AHIMA and the Florida Health Information Management Association. She

has written articles for state newsletters. Kathleen is a Certified Professional in Utilization

Review (CPUR). She holds a Master of Science Degree in Health Services Management, from

Florida Institute of Technology, in Orlando and a Bachelor of Science in Health Information

Management, from the University of Central Florida.

Lisa Kozakoff, RN, CPUR

Lisa is a Project Manager with 3M Consulting. She has more than 20 years of experience in

healthcare, including extensive experience in critical care and all areas of surgery including

open heart, vascular and general surgery. She has conducted over 200 physician presentations

related to ICD-9-CM coding and documentation in the medical record and the impact to the

3M™ APR DRG System. Lisa is responsible for coordination and management of all client

relations and on-site project activities, including team management, educational sessions and

executive meetings. She currently manages and oversees delivery of all our APR DRG

engagements and works with clients to analyze and interpret their monthly data to measure

program impact.

Her previous experience includes being a Senior Consultant of a national consulting firm, and

Director of Surgical Services; where she developed and implemented a pediatric Liver

Transplant Program, as well as a multi-specialty laser program; responsible for staff training,

quality assurance monitoring, disaster planning and daily operations.

Ms Kozakoff is a certified in Utilization Review (CPUR) and a Registered Nurse in the State of

Georgia

Audrey G. Howard, RHIA

Audrey is a Senior Consultant with 3M Health Information Systems, Consulting Services (3M

HIS/CS). She has consulted on numerous healthcare engagements nationally involving coding

validations, coding education, coding process improvement, quality and compliance reviews as

well as participating in the delivery of 3M’s concurrent DRG ASSURANCE™ program. She is

responsible for performing coding research and providing support for client coding questions.

Audrey resides on 3M HIS/CS coding roundtable and also contributes to 3M HIS/CS Quarterly

Newsletter. In addition, she researches and develops numerous training materials and

manuals. Audrey also authors coding columns in the

For the Record

publication.

Audrey has over 16 years of experience in Health Information Management. During her

professional career, she has functioned as a coder, senior DRG technician, coding supervisor,

assistant director of a Health Information Management Department and consultant. Her duties

CONTINUED

Faculty

AHIMA 2007 Audio Seminar Series iii

as assistant director included daily operations, managing bill hold, educating coding staff, and

supervising release of information. As assistant director, she also computerized the coding

process and streamlined the workflow. Her teaching experience includes advanced coding

classes and documentation programs related to reimbursement, coding, compliance, severity

and risk profiling. Audrey has worked with very large university hospitals, as well as multi-

hospital systems to implement documentation improvement programs.

Audrey is a Registered Health Information Administrator. She earned her Bachelor of Science

degree in Health Information Management from the University of Kansas in Lawrence, Kansas.

Table of Contents

AHIMA 2007 Audio Seminar Series

Disclaimer .....................................................................................................................i

Faculty .........................................................................................................................ii

Objectives ..................................................................................................................... 1

Cancer – Clinical Information ....................................................................................... 1-2

Facts About Cancer ..................................................................................................... 3-4

Cancer – Clinical Information

Risk Factors.......................................................................................................... 4

Tumor Antigens and Tumor Markers....................................................................... 5

Screening............................................................................................................. 6

Diagnosis.............................................................................................................. 6

Staging................................................................................................................. 7

TNM Staging System .......................................................................................... 8-9

Treatment – Surgery ............................................................................................10

Treatment – Radiation..........................................................................................10

Treatment – Chemotherapy...................................................................................11

Treatment – Biological Therapy.............................................................................11

Polling Question #1.......................................................................................................12

Coding of Neoplasms.....................................................................................................12

Neoplasm Table............................................................................................................13

Results of Poll #1.................................................................................................13

Behavior Classification..............................................................................................14-15

Neoplasm Coding Guidelines .....................................................................................16-19

Polling Question #2.......................................................................................................20

Neoplasm Coding Directives...........................................................................................20

Results of Poll #2.................................................................................................21

Lymphoma .............................................................................................................21-23

Common Neoplasm Related Questions.......................................................................23-24

Polling Question #3.......................................................................................................25

Common Neoplasm Related Questions.......................................................................25-26

Results of Poll #3.................................................................................................27

Resource/Reference List................................................................................................27

Audience Questions.......................................................................................................28

Audio Seminar Discussion..............................................................................................28

AHIMA Audio Seminars..................................................................................................29

Thank You (and Link for Certificate) ...............................................................................30

Appendix ..................................................................................................................31

CE Certificate Instructions.....................................................................................32

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 1

Notes

Comments

uestions

Objectives

Discuss clinical information related to

neoplasms

Review neoplasm terminology

Review the official ICD-9-CM coding

guidelines related to neoplasm coding

Apply ICD-9-CM diagnostic guidelines to

neoplasm case studies 1

Cancer – Clinical Information

Group of diseases characterized by uncontrolled

growth and spread of abnormal cells

Can develop from any tissue within any organ

Cells grow and multiply

Forms a mass of cancerous tissue that invades a

nearby tissue and can spread throughout the body

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 2

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uestions

Cancer – Clinical Information

Transformation: process of cancer cells developing from

normal cells

1. Initiation – change in cell’s genetic material caused by a

carcinogen

2. Promotion – a cell that has been initiated becomes cancerous

Carcinogen – substances that can cause changes that can

lead to cancer

•Examples:

•Chemical

•Virus/Infectious agents

•Radiation

•Sunlight

•Industrial processes

•Occupational exposures

•Carcinogens do not cause cancer in every case, all the time 3

Cancer – Clinical Information

A cancer cell is a cell whose biologic function has

been altered in such a way that it doesn’t

respond to the body’s normal mechanisms for

controlling cell growth and reproduction

Abnormal cells continue to grow and result in

cancer

Even if a cell becomes cancerous, it can be

destroyed by the immune system

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 3

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Facts About Cancer

About 1,444,920 new cancer cases are expected to be

diagnosed in 2007

•Estimate does not include carcinoma in situ of any site except

urinary bladder and does not include basal and squamous cell

skin cancers

More than 1 million cases of basal and squamous cell skin

cancer are expected to be diagnosed in 2007

About 559,650 Americans are expected to die of cancer in

2007

•Equates to more than 1,500 people a day

Cancer is the second most common cause of death in the US

(exceeded only by heart disease)

•In the US cancer accounts for about 1 of every 4 deaths

10.5 million Americans live with a history of cancer (as of

January 2003)

Information obtained from the American Cancer Society

Facts About Cancer

Site of Cancer

Prostate 218,890 29% 27,050 9%

Lung & Bronchus 114,760 15% 89,510 31%

Colon & Rectum 79,130 10% 26,000 9%

Urinary Bladder 50,040 7% 9,630 3%

Non-Hodgkin Lymphoma 34,200 4% 9,600 3%

Melanoma 33,910 4% Not Reported

Kidney & Renal Pelvis 31,590 4% 8,080 3%

Leukemia 24,800 3% 12,320 4%

Oral Cavity & Pharynx 24,180 3% Not Reported

Pancreas 18,830 2% 16,840 6%

Liver & Intrahepatic bile duct Not Reported 11,280 4%

Esophagus Not Reported 10,900 4%

All Sites 766,860 100

289,550 100

2007 Estimates - Male

Estimated New Cases Estimated Deaths

Excludes basal and squamous cell skin cancers and carcinoma

situ

except urinary bladder 6

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 4

Notes

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uestions

Facts About Cancer

Site of Cancer

Breast 178,480 26% 40,460 15%

Lung & Bronchus 98,620 15% 70,880 26%

Colon & Rectum 74,630 11% 26,180 10%

Uterine Corpus 39,080 6% 7,400 3%

Non-Hodgkin Lymphoma 28,990 4% 9,060 3%

Melanoma 26,030 4% Not Reported

Thyroid 25,480 4% Not Reported

Ovary 22,430 3% 15,280 6%

Kidney & Renal Pelvis 19,600 3% Not Reported

Leukemia 19,440 3% 9,470 4%

Pancreas Not Reported 16,530 6%

Brain & Other Nervous Sys Not Reported 5,590 2%

Liver & Intrahepatic Bile Duct Not Reported 5,500 2%

All Sites 678,060 100

270,100 100

2007 Estimates - Female

Estimated New Cases Estimated Deaths

Excludes basal and squamous cell skin cancers and carcinoma

situ

except urinary bladder 7

Cancer – Clinical Information

Risk Factors

•Genetic factors:

•Family history

•Chromosomal abnormalities (e.g., Down Syndrome)

•Environmental factors:

•Cigarette smoking

•Extended exposure to ultraviolet radiation

•Diet

•Exposure to chemicals such as asbestos

•Geographic location

•Virus (e.g., papillomavirus may cause cervical cancer,

cytomegalovirus may cause Kaposi’s sarcoma,

hepatitis B may cause liver cancer) 8

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 5

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Cancer – Clinical Information

Tumor antigens – foreign substance recognized

and targeted for destruction by the body’s

immune system

Tumor markers – antigens released into the

bloodstream by certain cancers which can be

detected by blood tests

•Not accurate enough to use as a screening tool

•Determines if cancer treatment is effective

•If the tumor marker disappears from the blood

sample, then the treatment has been successful

Cancer – Clinical Information

TesticularLactate dehydrogenase Multiple myelomaß2-microglobulin PancreaticCA 19-5 BreastCA 15-3 OvarianCA-125 ProstateProstate-specific antigen (PSA)

Cancer originating in placenta,

testicular

Beta-human chorionic gonadotropin

(ß-HCG)

Liver, ovarian, testicular, pineal gland

tumors

Alpha-fetoprotein (AFP)

Colon, breast, pancreas, bladder,

ovary, cervix

Carcinoembryonic antigen (CEA) CancerTumor Antigen

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 6

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Cancer – Clinical Information

Screening

•Identifies the possibility of cancer being

present

•Results of screening tests need to be confirmed

or disproved with further examinations

•Common screening tests:

•Papanicolaou (Pap) test to detect cervical cancer

•Mammography to detect breast cancer

•Allows cancer to be diagnosed in early stages

and prevents it from spreading

Cancer – Clinical Information

Diagnosis:

•Thorough history and physical examination

•Ultrasound

•Computed tomography (CT) scan

•Magnetic resonance imaging (MRI)

•Biopsy

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 7

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Cancer – Clinical Information

Staging

•Tests to determine:

•The specific type of cancer

•Tumor’s location

•Tumor’s size

•If it has metastasized

•Aids physicians in determining appropriate

treatment plan

•Determines prognosis

Cancer – Clinical Information

Staging

•Additional diagnostic tests performed that

identifies if cancer has spread:

•Liver scan

•Bone scan

•X-ray

•CT scan

•MRI

•Ultrasound

•Bone marrow biopsy

•Lymph node biopsy

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 8

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Cancer – Clinical Information

TNM staging system

•T – extent of the primary tumor

•TX means the tumor can't be measured or found

•T0 means there is no evidence of primary tumor

•Tis means the cancer is in situ (the tumor has not

started growing into the surrounding structures)

•The numbers T1–T4 describe the size and/or level of

invasion into nearby structures

–The higher the T number, the larger the size of the tumor and/or

the further it may have grown into nearby structures

Cancer – Clinical Information

TNM staging system

continued

•N – absence or presence of regional (nearby)

lymph node involvement

•NX means the nearby lymph nodes can't be measured

or found

•N0 means nearby lymph nodes do not contain cancer

•The numbers N1–N3 describe the size, location, and/or

the number of lymph nodes involved

–The higher the N number, the more involved the lymph nodes are

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 9

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Cancer – Clinical Information

TNM staging system

continued

•M – absence or presence of distant metastases

•MX means metastasis can't be measured or found

•M0 means there are no known distant metastases

•M1 means that distant metastases are present

Cancer – Clinical Information

TNM staging system

continued

•Once the TNM is determined, an overall stage of I, II, III,

or IV is assigned

•May also be subdivided using letters such as IIIA and

IIIB

Dukes system for colorectal cancer may still be

used by some physicians

The stage of cancer does not change over time,

even if the cancer progresses

•A cancer that comes back or spreads is still referred to by

the stage it was given when it was first diagnosed

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 10

Notes

Comments

uestions

Cancer – Clinical Information

Treatment

•Surgery – excision of the tumor from the body

•Radiation – treatment with high-energy rays

(such as x-rays) to kill or shrink cancer cells

•Radiation may come from outside of the body

(external radiation) or from radioactive materials

placed directly in the tumor (brachytherapy or internal

radiation)

•Radiation therapy may be used as the main treatment

for a cancer, to reduce the size of a cancer before

surgery, or to destroy any remaining cancer cells after

surgery

•In advanced cancer cases, it may also be used as

palliative treatment 19

Cancer – Clinical Information

Treatment

continued

•Radiation

continued

•Admit for radiotherapy – V58.0

–Excludes: admitted for radioactive implant which codes to the condition

•Radiotherapy procedure codes:

–92.20, Infusion of liquid brachytherapy radioisotope

–92.21, Superficial radiation

–92.22, Orthovoltage radiation

–92.23, Radioisotopic teleradiotherapy

–92.24, Teleradiotherapy using photons

–92.25, Teleradiotherapy using electrons

–92.26, Teleradiotherapy of other particulate radiation

–92.27, Implantation or insertion of radioactive elements

–92.28, Injection or instillation of radioisotopes

–92.29, Other radiotherapeutic procedure 20

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 11

Notes

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uestions

Cancer – Clinical Information

Treatment

continued

•Chemotherapy – treatment with drugs to destroy cancer

cells

•Chemotherapy is often used with surgery or radiation to

treat cancer when the cancer has spread, when it has come

back (recurred), or when there is a strong chance that it

could recur

•Admit for chemotherapy – V58.11

•Chemotherapy procedure code – 99.25

•Hormone Therapy – treatment with hormones, with

drugs that interfere with hormone production or

hormone action, or the surgical removal of hormone-

producing glands

•Hormone therapy may kill cancer cells or slow their growth

•Targeted therapy – treatment that attacks some part of

cancer cells that make them different from normal cells 21

Cancer – Clinical Information

Treatment

continued

•Biological therapy – substances that boost the

body's immune system to fight against cancer

•Also called biotherapy or immunotherapy

•Drugs classified as biological response modifiers

(BRMs) are:

–Aldesleukin (IL-2, Interleukin-2, Proleukin)

–Epoctin (Erythropoietin, Epogen, Procrit)

–Filgrastim (G-CSF, Neupogen)

–Interferon alfa 2 (Roferon A, Intron, Wellferon, Alferon)

–Levamisole hydrochloride (Erqumisol)

–Opreleukin (Neumega)

–Sargramostin (GM-CSF, Leukine)

•Admit for Immunotherapy (BRM) – V58.12

•Immunothera

rocedure code

–

99.28 22

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 12

Notes

Comments

uestions

Polling Question #1

A patient with a diagnosis of vaginal wall recurrence

from adenocarcinoma of uterus is admitted for

intracavitary radiation of the vaginal wall.

What procedure code should be assigned on this

case?

*1 Implantation or insertion of radioactive elements (92.27)

*2 Radiation therapy, unspecified (92.29)

*3 Chemotherapy (99.25)

*4 Immunotherapy (99.28)

Coding of Neoplasms

Most neoplasm codes are located in Chapter 2 of ICD-9-CM

(140-239)

•Some benign neoplasm codes are located in the specific body

system chapter

•Example: Prostatic adenoma = 600.2x

Reference the histological term first, if documented, in the

Alphabetic Index before going to the Neoplasm Table and

follow the instructional notes

Refer to the Neoplasm Table in the Alphabetic Index in ICD-

9-CM for appropriate code assignment

•Provides the proper code based on behavior of neoplasm (e.g.,

malignant, benign) and site

Always verify the code in the Tabular List 24

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 13

Notes

Comments

uestions

Neoplasm Table

Results Poll #1

A patient with a diagnosis of vaginal wall recurrence

from adenocarcinoma of uterus is admitted for

intracavitary radiation of the vaginal wall.

What procedure code should be assigned on this

case?

*1 Implantation or insertion of radioactive elements (92.27)

*2 Radiation therapy, unspecified (92.29)

*3 Chemotherapy (99.25)

*4 Immunotherapy (99.28)

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 14

Notes

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uestions

Behavior Classification

Malignant Neoplasm

•Tumor cells that may extend beyond the

primary site to adjacent structures or to

distant sites

•Two types of malignant neoplasms

•Primary neoplasm: Localized point of origin

•Secondary (metastatic) neoplasm: Site to

which the tumor has spread

–May be described as extension, invasion, or

metastasis

Behavior Classification

Carcinoma

in Situ

•Tumor cells undergoing malignant changes but

still confined to the point of origin without

invasion of the surrounding normal tissue

•Other terms included in carcinoma

in situ

•Intraductal

•Intraepithelial

•Noninfiltrating

•Noninvasive

•Preinvasive 28

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 15

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Behavior Classification

Benign neoplasm: Not invasive and do not

metastasize

Neoplasm of uncertain behavior: No

determination can be made if tumor cells

are benign or malignant

Neoplasm of unspecified nature: No

specification of type or morphology of

neoplasm

Behavior Classification

Bone

Brain

Diaphragm

Heart

Lymph nodes

Mediastinum

Meninges

Peritoneum

Pleura

Retroperitoneum

Spinal cord

Sites classifiable

to 195

The following sites are classified as secondary neoplasms

when not otherwise specified:

Assign code 155.2 for malignant neoplasms of the liver

that are not documented as either primary or secondary in

nature 30

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 16

Notes

Comments

uestions

Neoplasm Coding Guidelines

1. Designate the

malignancy

as the principal

diagnosis when the treatment is directed toward

the malignancy

2. Designate the

secondary site neoplasm

as the

principal diagnosis when the treatment is directed

only

toward the secondary (metastatic) neoplasm

even though the primary site is still present

•If the treatment is directed equally toward both the

primary and secondary sites, assign the primary

malignancy as the principal diagnosis (

AHA ICD-9-CM

Coding Handbook

, Faye Brown, 2004, page 300)

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164 31

Neoplasm Coding Guidelines

3. Follow these guidelines when coding complications

associated with malignant neoplasms:

•Sequence

anemia

as the principal diagnosis when the

admission is for management of anemia associated with the

malignancy or the therapy and the treatment is only directed

at the anemia

•Code assignment will depend on the specific type of

anemia documented

•Sequence

dehydration

as the principal diagnosis when the

admission is for management of dehydration due to the

malignancy or the therapy and only the dehydration is being

treated

•When the admission is for treatment of a complication

resulting from a surgical procedure, sequence the

complication

as the principal diagnosis if treatment is

directed at resolving the complication

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164 32

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 17

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Neoplasm Coding Guidelines

4. When the primary malignancy has been previously excised

or eradicated from its site and there is no adjunct treatment

directed at that site and no evidence of any remaining

malignancy at the primary site, use the appropriate code

from category V10, Personal history of malignant neoplasm,

to indicate the former site of the primary malignancy.

•Documentation of extension, invasion, or metastasis to another

site is coded as a secondary malignant neoplasm to that site

•The metastatic site may be sequenced as the principal

diagnosis if treatment is directed toward the metastatic site

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164

Neoplasm Coding Guidelines

5. Admission for treatment

•Sequence the

malignancy

as principal diagnosis when

the patient is admitted for surgical removal of a

malignancy followed by chemotherapy or radiation

therapy

•If the patient is admitted solely for the purpose of

receiving chemotherapy, immunotherapy or

radiotherapy, sequence code

V58.11 (Admit for

chemotherapy), V58.12 (Admit for immunotherapy), or

V58.0 (Admit for radiotherapy)

as the principal

diagnosis

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 18

Notes

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Neoplasm Coding Guidelines

5. Admission for treatment

continued

•If the patient receives more than one of the therapies

during the same admission, a

code will be assigned for

each therapy performed

and

any of them

may be

sequenced as principal diagnosis

•Sequence

V58.0, V58.11, or V58.12

as principal

diagnosis when the patient is admitted for radiation

therapy, chemotherapy, or immunotherapy and

complications develop due to the therapy

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164

Neoplasm Coding Guidelines

6. Sequence the

malignancy

(either the primary or

secondary) as the principal diagnosis if the

patient is admitted to determine the extent of the

malignancy (staging) or for a procedure such as

thoracentesis or paracentesis even though

chemotherapy or radiation therapy is

administered

7. Sequence the

malignancy

as principal diagnosis

when the patient is admitted with signs and

symptoms related to the malignancy

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, pp 161-164 36

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 19

Notes

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Neoplasm Coding Guidelines

8. Sequence

a code from subcategory V50.4, Prophylactic organ

removal

, as principal diagnosis if the patient is admitted for

prophylactic removal of breasts, ovaries, or another organ

•The prophylactic organ removal may be due to a genetic

susceptibility to cancer or a family history of cancer

•Assign codes for the genetic susceptibility and family history as

secondary diagnoses as necessary

•The prophylactic organ removal may be due to the patient

having a cancer of a site and wants to prevent either a new

primary malignancy at another site or a metastatic disease

•Assign the malignancy as an additional code with a code from

subcategory V50.4

•Do not assign code V50.4x if the organ removal is for treatment

of the malignancy

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, p 213 37

Neoplasm Coding Guidelines

9. Neoplasm related pain

•Assign code 338.3, Neoplasm related pain, for a patient that

has pain that is related to, associated with, or due to cancer

(either primary or secondary) or tumor regardless if the pain

is acute or chronic.

•Code 338.3 includes:

•Cancer associated pain

•Pain due to malignancy (primary) (secondary)

•Tumor associated pain

•Code 338.3 is sequenced as the principal diagnosis if the

reason for admission is for pain control/management

•Assign a code for the malignancy as a secondary diagnosis

•Code 338.3 may be sequenced as a secondary diagnosis if the

reason for admission is for management of the neoplasm and

the neoplasm related pain is also documented

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, p 171 38

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 20

Notes

Comments

uestions

Polling Question #2

A patient with a history of breast cancer is now admitted with

metastasis to the lung for partial pneumonectomy.

What diagnosis codes should be assigned on this case?

*1 Breast cancer (174.9) and secondary neoplasm of the lung

(197.0)

*2 Secondary neoplasm of the lung (197.0) and personal history of

breast malignancy (V10.3)

*3 Admit for chemotherapy (V58.11) and lung malignancy (162.9)

*4 Lung malignancy (162.9) and personal history of breast

malignancy (V10.3)

Neoplasm Coding Directives

If a patient is admitted with a non-neoplastic

condition for chemotherapy or immunotherapy,

assign the

condition

as the principal diagnosis

•Do not assign code V58.11 or V58.12

•Example: Admitted for chemotherapy to treat

macroglobulinemia

•Assign code 273.3. Do not assign code V58.11

AHA Coding Clinic for ICD-9-CM

1995, 4Q, p 81 and 1992, 3Q, pp 5-7

If a patient is admitted for radioactive implant,

assign the

malignancy

as the principal diagnosis

•Do not assign code V58.0

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 21

Notes

Comments

uestions

Results Poll #2

A patient with a history of breast cancer is now admitted with

metastasis to the lung for partial pneumonectomy.

What diagnosis codes should be assigned on this case?

*1 Breast cancer (174.9) and secondary neoplasm of the lung

(197.0)

*2 Secondary neoplasm of the lung (197.0) and personal history of

breast malignancy (V10.3)

*3 Admit for chemotherapy (V58.11) and lung malignancy (162.9)

*4 Lung malignancy (162.9) and personal history of breast

malignancy (V10.3)

Lymphoma

Lymphoma is a group of malignant diseases which originates

in lymph glands and other lymphoid tissue

Lymphatic system is responsible for moving the lymph from

the tissues to the bloodstream

Lymphatic system mainly consists of:

•Lymph nodes

•Lymph vessels

•Lymphatic ducts

Lymphatic organs include:

•Bone marrow

•Spleen

•Tonsils

•Thymus gland

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 22

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Lymphoma

Types of lymphoma include:

•Reticulosarcoma

•Lymphosarcoma

•Burkitt’s lymphoma

•Plasma cell lymphoma

•Mixed lymphoma

•Hodgkin’s disease

Signs and symptoms:

•Painless swelling in the lymph nodes in the neck, underarm,

or groin

•Fevers and chills

•Night sweats

•Persistent fatigue

•Weight loss

•Enlarged spleen

•Itching (pruritus) 43

Lymphoma

Diagnosis:

•Examination of the lymph nodes in the groin, underarm, and

neck to check for swelling or lumps

•Biopsy of lymph node

•Blood and urine tests

Diagnostic studies to confirm extent of involvement:

•Chest x-ray

•CT scan of abdomen and pelvis

•Bone marrow biopsy

Treatment:

•Chemotherapy

•Radiation therapy

•Stem cell transplantation

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 23

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Lymphoma

Lymph node metastasis vs. lymphoma

•Malignant neoplasm of the lymph node is presumed to be a

metastatic site (category 196)

•If documentation specifies that it is a primary lymph node

malignancy, assign a code from categories 200-202

Malignant neoplasms classified to categories 200-208 stated

as secondary or metastatic remain within the 200-208

category range and are not coded to category 196

If lymph nodes in more than one region of the body are

involved, assign the fifth digit of 8

Regardless of the number of sites involved, lymphoma is not

considered metastatic

Lymphoma patients who are in remission are still considered

to have lymphoma and should be assigned the appropriate

code from categories 200-202

AHA Coding Clinic for ICD-9-CM

, 1992, 2Q, p 3 45

Common Neoplasm Related

Questions

History of neoplasm still under treatment

•Assign a code for the malignancy if a patient is receiving

treatment (e.g., chemotherapy) for a malignancy that has

already been excised or previously treated

•Do not assign a code from category V10, Personal history

of malignant neoplasm, because the patient would not

still be under treatment if it were actually a history of

malignancy

•Example: A status post mastectomy patient is taking a

chemotherapeutic medication for the breast cancer

•Assign code 174.x. Do not assign code V10.3

AHA Coding Clinic for ICD-9-CM

1992, 3Q, p 7 and 1985, May-June, p 9

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 24

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Common Neoplasm Related

Questions

Tamoxifen

•Tamoxifen can be used for the treatment of breast

cancer or for the prevention of breast cancer

•Possible for patient to be maintained on tamoxifen for

years after surgery

•Assign a code from category 174, Malignant neoplasm of

female breast, when a patient is receiving tamoxifen for

the continuing treatment of primary breast cancer

•If a patient was previously treated for primary site

breast cancer (e.g., mastectomy, chemotherapy) and is

now maintained on tamoxifen for the prevention of

metastatic cancer, assign codes V58.69, Long-term

(current) use of other medication, and V10.3, Personal

history of breast cancer

Common Neoplasm Related

Questions

Tamoxifen

continued

•If a patient with a strong family history of breast cancer

is receiving tamoxifen prophylactically for the prevention

of breast cancer, assign codes V58.69 and V16.3, Family

history of breast cancer

AHA Coding Clinic for ICD-9-CM

, 2000, 2Q, pp 8-9

•Review the record carefully to determine the reason

the patient is being maintained on tamoxifen before

assigning a diagnosis code

•Cannot be automatically assumed that the patient is

being treated for breast cancer simply because the

patient is on tamoxifen

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 25

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Polling Question #3

A patient is admitted for a bilateral mastectomy.

The patient wants prophylactic breast removal due

to a strong family history of breast cancer.

What code should be sequenced as the principal

diagnosis?

*1 Breast cancer (174.9)

*2 Family history of breast malignancy (V16.3)

*3 Status post surgery (V45.89)

*4 Prophylactic breast removal (V50.41)

Common Neoplasm Related

Questions

Chemotherapy Induced Anemia

•Assign code 285.9 for chemo-induced anemia unless a

more specific type of anemia is documented

•Code 285.22, Anemia in neoplastic disease, should not be

used for this diagnosis

•Per

Coding Clinic

, “Code 285.22 is for use for anemia that

is due to the malignancy, not for anemia due to

antineoplastic chemotherapy drugs, which is an adverse

effect.”

AHA Coding Clinic for ICD-9-CM

, 2006, 4Q, p 167 50

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 26

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Common Neoplasm Related

Questions

Coding from Pathology Reports

•

In the inpatient setting

, a code cannot be assigned from

the pathology report alone without the physician

confirming the diagnosis in the body of the medical record

(e.g., progress notes or discharge summary)

•If the pathology report lists a diagnosis that is not

documented by the physician in the body of the medical

record, then the physician should be asked if it is

appropriate to add the diagnosis

•Example: Lymph node metastasis is identified in the

pathology report, and the physician does not document the

diagnosis in the progress notes or discharge summary

•Before assigning a code from category 196, the physician must

document the diagnosis

AHA Coding Clinic for ICD-9-CM

2006

7-8 and 2004

20-21 51

Common Neoplasm Related

Questions

Carcinomatosis

•Widespread neoplastic growth throughout the

body

•If individual sites are documented, all sites

should be coded separately

•If carcinomatosis is documented without

mention of specific sites, assign code 199.0,

Disseminated malignant neoplasm without

specification of site

AHA Coding Clinic for ICD-9-CM

, 1989, 4Q, p 10

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 27

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Results Poll #3

A patient is admitted for a bilateral mastectomy.

The patient wants prophylactic breast removal due

to a strong family history of breast cancer.

What code should be sequenced as the principal

diagnosis?

*1 Breast cancer (174.9)

*2 Family history of breast malignancy (V16.3)

*3 Status post surgery (V45.89)

*4 Prophylactic breast removal (V50.41)

Resource/Reference List

•

The Merck Manual of Medical Information Home

Edition

, Merck Research Laboratories, 1997,

pages 789-805

•American Cancer Society, www.cancer.org

•National Cancer Institute, www.cancer.gov

•AHIMA Web-based Coding Training

Oncology Services Coding in Hospitals

http://campus.ahima.org/campus/course_info/CATS/CATS_newtraining.html#onc

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 28

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Audience Questions

Audio Seminar Discussion

Following today’s live seminar

Available to AHIMA members at

www.AHIMA.org

Click on Communities of Practice (CoP) – icon on top right

AHIMA Member ID number and password required – for members only

Join the Coding Community from your Personal Page then

under Community Discussions, choose the

Coding Neoplasms Audio Seminar Forum

You will be able to:

•Discuss seminar topics

•Network with other AHIMA members

•Enhance your learning experience

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 29

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uestions

AHIMA Audio Seminars

Visit our Web site

http://campus.AHIMA.org

for information on the

2007 seminar schedule.

While online, you can also register

for seminars or order CDs and

pre-recorded Webcasts of

past seminars.

Upcoming Audio Seminars

Reporting Hospital Outpatient Modifiers

May 3, 2007

Coding for Gastrointestinal Endoscopy

May 10, 2007

Coding Neoplasms

AHIMA 2007 Audio Seminar Series 30

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Thank you for joining us today!

Remember −sign on to the

AHIMA Audio Seminars Web site

to complete your evaluation form

and receive your CE Certificate online at:

http://campus.ahima.org/audio/2007seminars.html

Each person seeking CE credit must complete the

sign-in form and evaluation in order to view and

print their CE certificate

Certificates will be awarded for

AHIMA and ANCC

Continuing Education Credit

Appendix

AHIMA 2007 Audio Seminar Series 31

CE Certificate Instructions

To receive your

CE Certificate

Please go to the AHIMA Web site

http://campus.ahima.org/audio/2007seminars.html

click on

“Complete Online Evaluation”

You will be automatically linked to the

CE certificate for this seminar after completing

the evaluation.

Each participant expecting to receive continuing education credit must complete

the online evaluation and sign-in information after the seminar, in order to view

and print the CE certificate.

Resourcebook_041207 9060 RB041207

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