1. Neoplasms Chapter II HS317b - Coding & Classification of Health Information

2. Neoplasm Can occur in all body systems Can be classified by anatomical site, behaviour and morphology. To code neoplasms think in terms of the disease process

3. Coding Rules for Neoplasms MRDx is based on what site they are treating (primary or secondary) Apply specificity standard Assign separate codes for each primary and secondary Morphology coding is optional C80 Malignant neoplasm without specification if documentation is vague

4. Primary Neoplasm Code to point of origin  This includes when cancer invades into adjacent tissue and is still connected to original site  Be as specific as documentation allows Code to site

5. Example: Ca of the small intestine C17Malignant neoplasm of small intestine  Duodenum (C17.0)  Jejunum (C17.1)  Ileum (C17.2)  Meckel’s diverticulum (C17.3)

6. Overlapping Boundaries (contiguous sites) Within a 3-digit category & point of origin is underdetermined Example:  C17.8Overlapping malignant lesion of small intestine

7. Overlapping sites within certain systems Overlaps the boundaries of three- character categories within certain systems. See note at beginning of neoplasm chapter E.g. Ca of stomach (C16.~) and small intestine (C17.~)  C26.8 Overlapping lesion of digestive system

8. Overlapping systems C02.8 Overlapping lesion of tongue C08.8 Overlapping lesion of major salivary glands C14.8 Overlapping lesion of lip, oral cavity and pharynx C21.8 Overlapping lesion of rectum, anus and anal canal C24.8 Overlapping lesion of biliary tract, C26.8 Overlapping lesion of digestive system C39.8 Overlapping lesion of respiratory and intrathoracic organs C41.8 Overlapping lesion of bone and articular cartilage C49.8 Overlapping lesion of connective and soft tissue C57.8 Overlapping lesion of female genital organs C63.8 Overlapping lesion of male genital organs C68.8 Overlapping lesion of urinary organs C72.8 Overlapping lesion of central nervous system

9. Metastatic Neoplasms When solid malignant neoplasms spread to other sites through local invasion of adjacent sites, metastasis to distant sites or seed. ICD-10 does not make a distinction between method of metastasis. This excludes local invasion into tissue within a body system (Code to point of origin). Other terminology—secondary neoplasm

10. Lymphomas and Leukemia These neoplasms do not metastasize to secondary sites. They circulate within the lymphatic or hematopoetic circulation and may occur in other sites within these tissues. Assigned to morphology rather than site.

11. Admissions following diagnosis of CA Patient admitted for definitive surgery to remove tissue from site of previous biopsy & pathology report is negative for malignancy.  MRDx is primary neoplasm  i.e.: Ca of breast. For diagnosing purposes a needle biopsy of lump shows CA. Patient admitted for lumpectomy & pathology was negative for malignancy

12. Follow up admissions Various scenarios can be encountered to allow one to code history or follow up codes  Recurrent malignancies  Interventions after diagnosis of Ca made  Observation for suspected malignancy  History of malignant neoplasms  Chemotherapy/Radiation  Prophylactic interventions

13. Recurrent Malignancies Example  Ca of right breast—lumpectomy removed entire lesion  A year later returns with lesion at site of previous lumpectomy. According to documentation this is a recurrence of the primary malignancy. Ca previously eradicated but recurrent in the same organ or tissue  Code as primary (unless documentation directs you differently)  Include code for history of malignancy  C50.90 Ca R breast + Z85.3 Personal history of malignant neoplasm of breast

14. Observation for suspected CA When a patient presents with symptoms but tests prove negative for malignancy  Malignancy is ruled out  No further treatment is necessary Code: Z03.1 Observation for suspected malignant neoplasm

15. History of Malignant Neoplasms Different scenarios  Personal history of malignancy  Follow up examinations after initial intervention  Family history of malignancy

16. Personal History – Z85.~ Never to be used as MRDx Always assign diagnosis type 3 Only assign for primary malignancies  When Ca has been completely eradicated/excised  No further treatment directed toward primary  No evidence of any remaining Ca at primary site  There is a recurrence at same site that was previously excised

17. Follow up Examination When no disease is found  Through follow up investigation  No treatment indicated MRDx: Z08.~Follow-up examination after treatment for malignant neoplasm Diagnosis type 3: Z85.~ Personal history of Ca

18. Family History of Ca Z80.~Family history of malignant neoplasm Never used as MRDx Assign diagnosis type 3 Denotes reason for prophylactic organ removal

19. Prophylactic Organ Removal There is a family history of malignancy  Z80.~ Family history of malignant neoplasm Tests like PSA (Prostate Specific Antigen) or CA 125 (Cancer Antigen) positive No disease is present MRDx: Z40.~~ Prophylactic organ removal

20. Complications of Malignancy If complications are the cause of admission  Complication is MRDx  Malignancy is coded & assigned diagnosis type 3  Common complications Bacterial sepsis Chemotherapy induced neutropenia Febrile neutropenia Dehydration Hypercalcemia

21. Neutropenia An abnormally low level of neutrophils in the blood. Neutrophils are white blood cells produced in the bone marrow that ingest bacteria.

22. Neutropenia It is sometimes called agranulocytosis or granulocytopenia. It is a serious disorder because it makes the body vulnerable to bacterial & fungal infections.

23. Neutropenia may result from three processes  Decreased WBC production  Destruction of WBCs  Sequestration and margination of WBCs

24. Recovery from acute neutropenia depends on the severity of the patient infection & the promptness of treatment. When both neutropenia & fever are documented in the chart, code both D70.0 Neutropenia & R50.9 Fever, unspecified.

25. Dagger †/Asterisk * Standard Dual Combination for circumstances when there are two codes for diagnostic statements containing information about both an underlying generalized disease and a manifestation in a particular organ or site which is a clinical problem in its own right.  † code marks the primary code for the underlying disease  * code marks the manifestation code.

26. Dagger †/Asterisk * Dagger † may be MRDx, diagnosis type 1, 2 or 3. Asterisk * is always diagnosis type 3 and may never be used alone.  “in”, “due to” or “with” Anaemia in neoplastic disease  D63.0*Anaemia in neoplastic disease (C00-D48†)

27. Folio Lookup Cancer - see also Neoplasm, malignant (8000/3)

28. 8000/3 = Morphology Classification Describes the cell of origin (histological type) Describes the behaviour of the neoplasm Optional to use Always Diagnosis type 4 When morphology diagnosis contains two qualifying adjectives, the higher # should be used

29. Five digits  First four # identify histological type of neoplasm 8000Neoplasm 8140Adenocarcinoma NOS 8140Adenocarcinoma, metastatic NOS

30. /Fifth # indicates behaviour  /0 Benign  /1 Uncertain whether benign or malignant  /2 Carcinoma in situ  /3 Malignant, primary site  /6 Malignant, metastatic site  /9 Malignant, uncertain whether primary or metastatic

31. Review of Coding Neoplasms Code to point of origin Has the malignancy been either excised or eradicated? Is no further treatment being directed to the primary site? Is there no further evidence of remaining malignancy at the primary site. Account for primary with either malignant code or ‘history of’ code

32. Interventions Therapeutic Destruction, excisional partial, excisional total, excisional radical or excision with reconstruction Diagnostic  Inspections (endoscopy) biopsies

33. Chemotherapy  MRDx is Z51.1 Chemotherapy session for neoplasm Neoplasms (active & historical malignancies) may be coded as diagnosis type 3 Intervention: 1.ZZ.35.~ ~ (identify specific drug) for systemic or total chemotherapy

34. Radiation  MRDx is Z51.0 Radiotherapy session  Neoplasm (active & historical malignancies) may be coded as diagnosis type 3)  Intervention 1.~ ~. 27. ~ ~ Radiation therapy includes anatomical site & type of radiation.

35. Brachytherapy  MRDx is malignancy  Intervention is 1.QT. 26. ~ ~ (implant of radioactive material)

36. Classification of Neoplasm MRDx MCC 17 Lymphoma, Leukemia or unspecified site neoplasms MCC 17A Lymphoma or leukemia  Bone marrow transplant will be assigned to CMG 700 Bone Marrow Transplant  CMG 725 Major Leukemia and Lymphoma Procedures Open biopsies, Ventricular shunts, Excisions

37. Classification of Neoplasm MRDx MCC 17B Neoplasms of unspecified site  Medical partition – Radiation CMG 735, Chemotherapy CMG 736  Similar surgical procedures as MCC17A