July 9, 2007

Neoplasm Guidelines
For The Record
Vol. 19 No. 14 P. 35

Admission for Malignancy
Coders should use the following guidelines when a patient is admitted with a neoplasm:

• Designate the malignancy as the principal diagnosis when the treatment is directed toward
the malignancy.

• 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).

• When the primary malignancy has been previously excised or eradicated from its site and there is no adjunct treatment directed at that site nor any 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.

• Sequence the malignancy (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.

• Sequence the malignancy as the principal diagnosis when the patient is admitted with signs and symptoms related to the malignancy.

Complications Associated With Malignancy or Treatment
Patients admitted to the hospital due to a complication or treatment of the malignancy have additional guidelines that need to be followed. Anemia should be sequenced 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. The specific code assignment for anemia will depend on the specific type of anemia documented by the physician.

Dehydration should be sequenced as the principal diagnosis when the admission is for management of dehydration due to the malignancy or therapy and only the dehydration is being treated.

When the admission is for the treatment of a complication resulting from a surgical procedure, sequence the complication as the principal diagnosis if the treatment is directed at resolving the complication.

The code for radiotherapy (V58.0), chemotherapy (V58.11), or immunotherapy (V58.12) should be sequenced as the principal diagnosis when the patient is admitted for radiation therapy, chemotherapy, or immunotherapy and complications develop during the hospital stay due to the therapy.

Admission for Treatment
The malignancy should be sequenced as the principal diagnosis when the patient is admitted for surgical removal of a malignancy followed by chemotherapy or radiation therapy.

When a patient is admitted for treatment of a malignant neoplasm, the following guidelines apply:

• Admission for radiotherapy: Assign code V58.0 as the principal diagnosis, followed by the malignancy code as the secondary diagnosis.

• Admission for chemotherapy: Assign code V58.11 as the principal diagnosis, followed by the malignancy code as the secondary diagnosis.

• Admission for immunotherapy: Assign code V58.12 as the principal diagnosis, followed by the malignancy code as the secondary diagnosis.

If the patient receives more than one therapy during the same admission, a code will be assigned for each therapy performed, and any of them may be sequenced as the principal diagnosis.

If a patient with a non-neoplastic condition is admitted for chemotherapy or immunotherapy, assign the condition as the principal diagnosis. Do not assign code V58.11 or V58.12. For example, a patient admitted for chemotherapy to treat macroglobulinemia is assigned to code 273.3 (AHA Coding Clinic for ICD-9-CM, 1995, fourth quarter, page 81, and 1992, third quarter, pages 5-7).

If a patient is admitted for radioactive implant, assign the malignancy as the principal diagnosis. Do not assign code V58.0.

Prophylactic Organ Removal
Sequence a code from subcategory V50.4, Prophylactic organ removal, as the principal diagnosis if the patient is admitted for prophylactic removal of the breasts, ovaries, or other organ. The prophylactic organ removal may be due to a genetic susceptibility to cancer or 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 cancer at a site and wanting to prevent 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.

Coding and sequencing for neoplasms are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.